A New Joystick Technique for the Reduction of Unstable Trochanteric Hip Fractures: Especially With Rotational Deformity

Abstract

We are performing surgical treatment of trochanteric hip fractures using an intramedullary nail. There are irreducible fractures in which the correct reduction cannot be performed with the usual traction and internal rotation. In particular, the rotational deformity is difficult to reduce. One of the causes of this is the instability and uncontrollability of the proximal bone fragment. To address this problem, we devised a new joystick technique. From the same skin incision as used for inserting the intramedullary nail, a 3.0 mm Kirschner wire (K-wire) is inserted into the femoral neck perpendicularly. A K-wire is inserted at the front part of the femoral neck so as not to interfere with the lag screw. The fracture is reduced by operating the proximal bone fragment by using the K-wire as a joystick. The proximal bone fragment is operated in the varus-valgus direction by moving the K-wire proximally-distally and in internal-external rotation directions by moving the K-wire anteriorly-posteriorly. No complications, such as cut-out of the femoral neck due to the K-wire or neurovascular injury, were observed. The joystick technique was used in the following situations: (1) stabilization of the proximal bone fragment, (2) rotational reduction of the proximal bone fragment, and (3) prevention of rotational deformity caused by lag screw insertion. This joystick technique is simple and less invasive so we do not consider it a problem to apply it routinely, in all cases.

Comparative Outcome of Short Proximal Femoral Nail Versus Proximal Femoral Locking Compression Plate in the Management of Unstable Trochanteric Fractures

“…The uninjured limb was placed in abduction on the fracture table. An attempt was made for closed reduction using any of the following maneuvers-reduction with direct traction, abduction and external rotation; joystick with the help of a 3.0 mm Kirschner wire (K-wire) inserted perpendicularly into the front part of the femoral neck and cerclage wiring technique [15][16][17]. An open reduction was performed, if the closed method failed to reduce the fracture.…”