Floating elbow in children: Factors associated with serious complications

Abstract

Objectives: Simultaneous ipsilateral humerus and forearm fractures are rare injuries commonly caused by high-energy trauma. They are known for their higher potential for complications than isolated injuries on the same sites. There is no standardized management nor universally accepted classification for this condition. This study aimed to describe our experience with these injuries. Methods: This is a retrospective study of consecutive cases treated from June 2018 to December 2022. The following variables were assessed: age, sex, affected side, mechanism of injury, type of humeral fracture, type of forearm fracture, presence of bone exposure, associated injuries, treatment performed, complications, and elbow functionality according to the Mayo Elbow Performance Score (MEPS). Results: Thirty-four cases were analyzed, 58.8% of which were male. The mean age was 6.7 years (6 months–15 years). The most frequent mechanism was spin cycle rotatory injuries. The most affected location in the humerus was the diaphysis (55.8%), and 79.4% of fractures involved both forearm bones. Open fractures accounted for 23.5% of the cases. Regarding the treatments performed, fixation of at least one bone was performed in 32 cases (94%), and both sites were fixed in 24 cases (70.5%). Complications occurred in 26.5% of cases, of which 8.8% were compartment syndromes, and no implant-related infections were reported. All compartment syndromes were related to the torsion trauma caused by the spin cycle rotatory injuries. Elbow function graded according to the MEPS was excellent in 50% of patients. Conclusion: Floating elbow injuries are rare serious injuries. Spin cycle rotatory injuries further increase the complexity of treatment and the potential for complications.