Floating elbow injuries in adults: prognostic factors affecting clinical outcomes

• Published in: Journal of shoulder and elbow surgery 2013, Vol.22 (1), p.74-80
• Main Authors: Ditsios, Konstantinos, MD, PhD, Boutsiadis, Achilleas, MD, Papadopoulos, Pericles, MD, PhD, Karataglis, Dimitrios, MD, PhD, Givissis, Panagiotis, MD, PhD, Hatzokos, Ippokratis, MD, PhD, Christodoulou, Anastasios, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; clinical outcomes; Elbow Joint - injuries; Female; Floating elbow; Humans; Humeral Fractures - complications; Humeral Fractures - surgery; Intra-Articular Fractures - complications; Intra-Articular Fractures - surgery; Male; Middle Aged; Multiple Trauma - surgery; Orthopedics; Prognosis; prognostic factors; Radius Fractures - complications; Radius Fractures - surgery; Treatment Outcome; Ulna Fractures - complications; Ulna Fractures - surgery; Young Adult
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2012.09.005

Background Floating elbow fractures in adults are rare and complex injuries with unpredictable outcomes. The present study was designed to assess our experience, analyze possible compilations and illustrate prognostic factors of the final outcome. Methods Between 2002 and 2009, 19 patients with floating elbow fractures were treated in our department (mean follow-up, 26 months). The fractures were open in 10 patients (52.6%), and concomitant nerve palsy was present in 10 patients. Although the term “floating elbow” refers only to concomitant ipsilateral humeral and forearm shaft fractures, we also included injuries with intra-articular involvement. We categorized the patients into 4 groups: group I (10 patients) included shaft fractures of humerus and forearm, group IIa (5 patients) and IIb (1 patient) included partial intra-articular injuries, and group III (3 patients) involved only intra-articular comminuted fractures of the elbow region. Results Fracture healing was observed 14 weeks postoperatively, except in 2 patients, in which elbow arthroplasty was applied, and in 1 with brachial artery injury. Nine patients with nerve neuropraxia recovered 4 months postoperatively, and tendon transfers were necessary in 1 patient. Recovery in patients with nerve palsy was worse than in those without nerve injury (Mayo Elbow Performance Score, 73 vs 88.34; Khalfayan score, 72 vs 88.3). In addition, intra-articular involvement (groups II and III) negatively influenced the final clinical outcome compared with isolated shaft fractures (group I; Mayo Elbow Performance Score, 71.1 vs 88.5; Khalfayan score, 72.67 vs 86.1). Conclusions Although the nature of floating elbow injuries is complex, the presence of nerve injury and intra-articular involvement predispose to worse clinical outcomes.