The use of percutaneous joystick reduction and limited open reduction techniques in pediatric femoral shaft fractures: a study of 63 cases

Our study aimed to compare the effectiveness and clinical outcomes of percutaneous joystick reduction and limited open reduction for flexible intramedullary nailing in the treatment of pediatric femoral shaft fractures. A total of 63 pediatric femoral shaft fractures were studied: 35 fractures were treated with percutaneous fixation using the K-wire pin as a joystick (group A), whereas 28 fractures were treated with limited open reduction (group B). Clinical and radiographic data at the final follow-up were compared between the surgical groups. Their duration of X-ray exposure, postoperative weight-bearing time, healing time, Harris score, and Hospital for Special Surgery score at the last follow-up did not differ statistically. However, the blood loss, operative time, duration of hospital stay, and postoperative pain at the incision site were considerably lower in group A than in group B. Three and two patients from group A and group B, respectively, reported skin irritation, whereas one patient from group B developed infection. Seven patients in group A and eight patients in group B showed some extremity overgrowth (<2 cm) and no redisplacement or delayed union of fracture, iatrogenic vessel and nerve injury, or osteofascial compartment syndrome was reported in any of the groups. Therefore, we conclude that percutaneous joystick reduction may effectively be used for flexible intramedullary nailing in the treatment of pediatric femoral shaft fractures.Level III, retrospective comparative study.