Application of unilateral external fixation by the "joystick technique" in the treatment of pediatric tibia shaft fractures: technical note

Background The aims of current study were to present the clinical outcomes in patients with pediatric tibia shaft fractures who were treated with unilateral external fixation combined with joystick for fracture reduction and describe the details of our technique. Methods We retrospectively analyzed the patients with pediatric tibia shaft fractures who were treated with unilateral external fixation combined with joystick for fracture reduction between July 2018 and March 2020. The clinical outcomes were evaluated. Results A total of 23 patients were included in the current study with the average age of 8.0 years (ranged 4-14 years). The average duration of hospital and follow-up were 5.9 days (ranged 4-8 days) and 17.4 months (ranged 8-27 months), respectively. At postoperative 3 days, the visual analog scale (VAS) score was 3.1 +/- 1.43, which was significantly lower than the preoperative score of 7.3 +/- 1.5. Of these, 2 cases showed redness and swelling of pin-tract and exudation at postoperative 1 month, who improved after oral antibiotics without causing fixation failure. The average time to full weight-bearing without crutches was 5.1 weeks (ranged 3-8 weeks). All patients achieved fracture healing and good functional recovery. No complications including fixation failure, reoperation, epiphyseal injury occurred, infection around implants, vessel damage, nerve damage, and limitation of joint movement were observed. The Johner-Wruh scores showed that 21 cases (91.3%) were "excellent" and 2 cases (8.7%) were "good." Conclusions This procedure had advantages of simple operation, minimum trauma, early recovery of lower limb function, and no risk of complications. It may provide a new choice for children with tibia shaft fractures who require surgical treatment.