Floating-dislocated elbow in adults: Case reports and literature review

Abstract

Rationale: Floating-dislocated elbow is a severe and extremely rare injury in adults. Reviewing the literature, we found around 6 case reports regarding floating-dislocated elbow in adults.

Patient concerns and diagnoses: We report 2 cases of this unusual injury association. Both patients suffered a high energy trauma - fall from a height. Initial X-rays (radiography) revealed in both cases the fractures above and below the elbow (floating elbow) and associated elbow dislocation (floating-dislocated elbow). One case was a type IIIB Gustilo-Anderson open fracture-dislocation with an intra-articular component (olecranon fracture).

Interventions and outcomes: Each case had his own management problem regarding what to treat first: the dislocation or the associated fractures? Fractures were treated surgically by reduction and internal fixation, and after elbow dislocation reduction, the upper limb was immobilized in a long, well-padded plaster, with the elbow in 90° of flexion, for 3 weeks. Bone union was observed radiographically at 2 months after surgery in both cases. At the 2-year follow-up we recorded full upper limb recovery in terms of muscular trophism and elbow full range of motion.

Lessons: In addition to adding 2 new cases to a lower number of such lesion associations in adults, we also added a new variant of floating-dislocated elbow which has not been reported until now in the literature. Prompt management of these injuries, with stable fixation of the fractures allowed for early rehabilitation with excellent 2-years functional outcome.

Figure 1.

(A) Initial X-ray (antero-posterior view) of the arm – displaced middle third humeral shaft fracture and postero-lateral elbow dislocation. (B) Initial X-ray (lateral view) of the forearm – proximal third radial shaft and distal third ulnar fractures, and posterior elbow dislocation. (C) Postoperative X-rays (antero-posterior view) of the arm – humeral shaft fracture reduction and fixation with a locked intramedullary nail. (D, E) Postoperative X-rays (antero-posterior and lateral views) of the forearm – reduction of fractures and fixation with plates, reduction of the elbow dislocation.

Figure 2.

(A) Clinical appearance of the posttraumatic elbow wound. (B) Intra-articular elbow wound detail with direct visualization of elbow dislocation and olecranon fracture. (C) Initial X-ray (antero-posterior view) of the arm – displaced middle third, oblique, humeral shaft fracture, olecranon fracture and postero-medial elbow dislocation. (D) Initial X-ray (antero-posterior view) of the forearm – displaced proximal third, complex ulnar fracture, also reveals the medial elbow dislocation. (E) Postoperative X-ray (lateral view) of the arm - humeral shaft fracture reduction and fixation with a locked intramedullary nail, reduction of the olecranon and proximal third ulnar shaft fractures and fixation with a tension band, reduction of the elbow dislocation.