Management of floating arm: a case report

Abstract

Introduction and importance: The floating arm is a rare fracture, and so far there have been few cases reported. The treatment of this type of fracture is challenging and depends on several factors including age, underlying conditions, daily level of activity, fracture pattern, surgeon’s experience, and availability of devices. Case presentation: This study report a 59-year-old man with a rare humeral fracture and a severe crush injury of the forearm. There is a paucity of evidence regarding the management of concomitant floating arm and soft tissue injuries in the literature. The patient was managed by minimally invasive plate osteosynthesis (MIPO) and vacuum-assisted closure (VAC) followed by a split-thickness skin graft. Clinical discussion: The concurrent presence of the two pathologies exacerbated the patient’s condition and made the management challenging. In this case, the authors have used the MIPO approach to fix both fractures with minimal soft tissue injury. To manage the prominent soft tissue injury, we applied the VAC device. VAC has the advantages of reducing edema, controlling bacterial growth, and promoting granulation tissue formation, leading to faster cellular turnover and healing. Conclusions: In patients with floating arm, especially with concomitant soft tissue damage, the MIPO approach is a safe, minimally invasive, and quick method with minimal bleeding.