Forearm Fixation is Not Necessary in the Treatment of Pediatric Floating Elbow

Blumberg, Todd J.; Bremjit, Prashoban; Bompadre, Viviana; Steinman, Suzanne

doi:10.1097/bpo.0000000000000774

Cited by 15 publications

(8 citation statements)

References 14 publications

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“…Distal forearm association was more prevalent with subdivision into metaphyseal and physeal distal radius fractures. The location of the fracture in the proximal forearm suggested more traumatic force [ 9 , 10 ]. Moreover, it could be an open or closed injury.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Floating Elbow Caused by a Novel Mechanism: A Case Report

Al-Battat¹,

Alhathloul²,

Saleh³

et al. 2022

Cureus

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A pediatric floating elbow is a rare condition in which there is a humeral supracondylar fracture with an ipsilateral fracture of one or both bones of the forearm. We report a case caused by an unusual mechanism of a semi-automatic washing machine. This injury, on its own, involves the risk of compartment syndrome, however, this particular child came late. We present our approach to this challenging injury along with the controversial management in the literature.

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Section: Discussionmentioning

confidence: 99%

Pediatric Floating Elbow Caused by a Novel Mechanism: A Case Report

Al-Battat¹,

Alhathloul²,

Saleh³

et al. 2022

Cureus

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“…Blumberg et al concluded that a floating elbow could be safely managed with operative stabilization of the supracondylar humerus fracture alone. 102…”

Section: Complicationsmentioning

confidence: 99%

Management of supracondylar fractures of the humerus in children

2018

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Supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five to eight years.Extension-type fractures represent 97% to 99% of cases. Posteromedial displacement of the distal fragment is the most frequent; however, the radial and median nerves are equally affected. Flexion-type fractures are more commonly associated with ulnar nerve injuries.Concomitant upper-limb fractures should always be excluded. To manage the vascular status, distal pulse and hand perfusion should be monitored. Compartment syndrome should always be borne in mind, especially when skin puckering, severe ecchymosis/swelling, vascular alterations or concomitant forearm fractures are present.Gartland’s classification shows high intra- and inter-observer reliability. Type I is treated with casting. Surgical treatment is the standard for almost all displaced fractures. Type IV fractures can only be diagnosed intra-operatively.Closed reduction and percutaneous pinning is the gold standard surgical treatment. Open reduction via the anterior approach is indicated for open fractures, absence of the distal vascular flow for > 10 to 15 minutes after closed reduction, and failed closed reduction.Lateral entry pins provide stable fixation, avoiding the risk of iatrogenic ulnar nerve injury.About 10% to 20% of displaced supracondylar fractures present with alterations in vascular status. In most cases, fracture reduction restores perfusion.Neural injuries occur in 6.5% to 19% of cases involving displaced fractures. Most of them are neurapraxias and it is not routinely indicated to explore the nerve surgically.Cite this article: EFORT Open Rev 2018;3:526-540. DOI: 10.1302/2058-5241.3.170049

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“…Blumberg reviewed 47 children with supracondylar humeral fracture in which 21 of them had associated displaced forearm fracture; all the supracondylar fracture were managed surgically and all the forearm were immobilized with noncircumferential cast and none of those 21 children developed compartment syndrome. [42] Another recent retrospective review of 150 ipsilateral supracondylar humerus and forearm fractures did not identify any compartment syndrome in these children. [43] There is controversy in which fracture to fix first and whether to fix humeral fracture and to conservatively manage the forearm fracture but rigid stable fixation of all the fractures has been accepted as the best choice for the treatment of floating elbow injuries.…”

Section: Floating Elbowmentioning

confidence: 99%

The term “floating” used in traumatic orthopedics

Mohamed¹,

Ju²,

Qin

et al. 2019

Medicine

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Background: The term “floating” is used in orthopedic literature to describe certain patterns of skeletal injuries that share one common character which is disruption and discontinuity of bones above and below a joint. The first time used in orthopedic literature being in late 1970 to describe a type of elbow injury. Later the word was used increasingly and applied to a variety of injuries affecting the knee, shoulder, hip, forearm, hand, and ankle. Currently, there are about 12 different skeletal injuries described as floating. Objectives: The aim of this article was to define the term “floating” used in traumatic orthopedics and to discuss its history, mechanism of injury in each region, treatment and outcomes based on the currently available literature. As there were many separate articles describing different sites of floating injuries, this review aimed to summarize all floating injuries into 1 article.

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Forearm Fixation is Not Necessary in the Treatment of Pediatric Floating Elbow

Abstract: Level IV.

Cited by 15 publications

References 14 publications

Pediatric Floating Elbow Caused by a Novel Mechanism: A Case Report

Pediatric Floating Elbow Caused by a Novel Mechanism: A Case Report

Management of supracondylar fractures of the humerus in children

The term “floating” used in traumatic orthopedics

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