Management of "floating elbow" in children

Abstract

Background: Supracondylar fractures associated with ipsilateral forearm fractures, aptly termed as "floating elbow" is a rare injury in children after a fall from height. The various authors have reported their results with conservative treatment of one or both injuries to aggressive emergency operative fixation of both components.

Materials and methods: During a period of three years, the author managed four cases of floating elbow in children. All cases were managed by closed reduction and pinning of both components of the injury.

Results: All patients recovered full elbow range of motion at three months followup and were rated as excellent as per modified Flynn's criteria. None of the patients developed cubitus varus deformity, complications related to the pins or delayed union.

Conclusions: Early closed reduction and K wire fixation of both components of this injury gives better stability and prevents development of complications like compartment syndrome and elbow deformities.

Keywords: Floating elbow; forearm fracture; supracondylar fracture.

Figure 1 (A-D)

(A) X-ray of the elbow and forearm shows supracondylar fracture with ipsilateral fracture of both bone forearm in a 11 yrs old boy. (B) Line diagram of the same patient. (C) Post-operative X-ray of the elbow shows closed K-wire fixation of supracondylar fracture. (D) X-ray of the wrist shows closed percutaneous pinning of distal radius fracture

Figure 2(A-B)

(A) X-ray of the elbow and forearm shows supracondylar with distal radius fracture. (B) Lateral view shows gross displacement of supracondylar fracture

Figure 2 (C-E)

(C) AP X-ray of elbow shows precutaneous pinning of supracondylar fracture with callus formation. (D) AP and lateral X-ray (E) of distal forearm and wrist shows percutanous pinning of distal radius fracture