Repeated floating elbow injury after high-energy trauma

Abstract

The floating elbow is an uncommon injury occurring both in children and in adults. Two reports of rare variants of floating elbow injury have been published, but to the best of our knowledge, no recurrence of this injury has been described. We present a complex pattern of floating injury, occurring in the same limb 3 years after a floating elbow lesion, which included supracondylar fracture of the humerus and associated ipsilateral midshaft fracture of forearm bones. Satisfactory outcomes were finally obtained. This clinical case illustrates the importance of carefully assessing floating elbow injuries when they occur to optimize the surgical strategies and the adequate timing of the treatment. A comprehensive literature review of the floating elbow injuries is here reported.

Electronic supplementary material: The online version of this article (doi:10.1007/s11751-011-0102-7) contains supplementary material, which is available to authorized users.

Keywords: Difficult hardware removal; Floating elbow injury; Open reduction and internal fixation; Recurrence of fractures.

Fig. 1

Plain radiographs (a, b) showing the healing of fractures 1 year after the first floating elbow injury

Fig. 2

AP (a) and lateral (b) radiographs at hospital admittance show supracondylar fracture of the humerus and midshaft fractures of radius and ulna (second floating elbow injury). The CT scan (c) of distal humerus demonstrates the intercondylar integrity with an intra-articular bridge resulting from the previous treatment

Fig. 3

The radial nerve is proximally dissected so that its course on the posterior side of the humerus is clearly identified and the Y plate can be safety positioned

Fig. 4

Anteroposterior and lateral radiographs showing healing of forearm (a, b) and humeral (c, d) fractures 1 year postoperatively

Fig. 5

Photographs (a, b, c, d) showing active motion of the right elbow in comparison with the uninjured contralateral limb 18 months after the second injury