Arthroscopy-assisted Reduction and Fixation of Valgus-Impacted Femoral Neck Fractures with Joystick Technique

Valgus-impacted femoral neck fractures remain a challenging clinical entity. Associated deformities such as posterior tilt of femoral head, coxa valgus, and femoral neck shortening may produce femoroacetabular impingement, which adversely impacts on long-term joint function. Current reduction techniques face limitations: closed methods often fail to achieve satisfied reduction, open reductions require extensive soft-tissue dissection, and percutaneous joystick techniques are frequently fluoroscopy-dependent and imprecise. To address these problems, we describe a hip arthroscopy-assisted joystick reduction technique to achieve anatomical realignment. Under direct arthroscopic visualization, a Kirschner wire is precisely inserted into the femoral head to serve as joystick, allowing simultaneous correction of posterior tilt and valgus deformity. Real-time confirmation of reduction is followed by internal fixation using multiple cannulated screws. This technique provides direct visualization of both joystick placement and reduction maneuvers, minimizes fluoroscopy use, and allows for simultaneous joint decompression. By combining the accuracy of open visualization with the minimal invasion nature of percutaneous methods, this approach offers a promising solution for achieving anatomical fracture reduction for valgus-impacted femoral neck fractures.