Simultaneous Ipsilateral Pediatric Fractures of the Elbow and Forearm Attending a Tertiary Care Hospital

Abstract

Introduction: Ipsilateral supracondylar humerus and forearm fractures in the pediatric population are an uncommon injury associated with high-energy trauma. The incidence varies between 3% and 13%. Our aim was to conduct a descriptive analysis on seventeen cases of children with floating elbow injuries who attended our institution and to review the literature relating to this topic.
 
 Methods: Between April 2013 to March 2016, data were obtained through the medical records. Children who had completely displaced supracondylar fractures of the humerus associated with ipsilateral forearm fracture were reviewed. All patients underwent operative reduction and percutaneous K-wire stabilization. At mean follow up of 12.9 months, all patients were assessed clinically and radiologically. The following variables were used: age, gender, side, mechanism, type of fracture, classification, treatment and complications.
 
 Results: Seventeen pediatric "floating elbow" cases that had operative management were identified. Twelve (70.5%%) were male and five (29.4%) female. The mean age was 9.5 (SD=2.1) years, ranging from six to 14 years. The left side was predominantly affected (70.5%). The commonest injury mechanism was fall from a height (76.47%). All the supracondylar fractures were Gartland type III. Majority of forearm fractures (76.4%) were at distal meta diaphyseal region. Distal radius physeal fractures were diagnosed in three patients. Open fractures occurred in three cases (17.6%). All supracondylar fractures were reduced and fixed using K-wires. There was one radial nerve, and three median nerve injury. Five patients had pin tract related complications. Fifteen (88.2%) patients had good to excellent, two had fair in terms of modified Flynn criteria in last month follow up. All patients went on to radiographic union without secondary procedures.
 
 Conclusions: This, uncommon injury in most cases, results from high-energy trauma. Early surgical treatment for both fractures is required in the form simultaneous closed reduction of the displaced forearm fracture followed by supracondylar fixation with K-wires. This provides not only stable fixation but also allows close observation for early sign and symptom of development of compartment syndrome.

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

“…Moreover, it could be an open or closed injury. The prevalence of open injuries varies from 13-22% and are more in humeral rather than forearm fractures [ 7 , 8 , 11 , 12 ]. In our case, we report a peculiar rotational injury by a semi-automatic washing machine.…”

“…We preclude conservative treatment for the forearm with merely circumferential immobilization to prevent increasing compartmental pressure. The priority of reduction and fixation based on whether forearm or supracondylar is still debatable [ 6 , 11 ]. Hence, we started with forearm fixation with TENs.…”

Close Reduction Percutaneous Pinning (CRPP) versus Open Reduction Internal Fixation (ORIF) for Pediatric Supracondylar Humerus Fractures Gartland Type II and III: A Systematic Review and Meta-analysis

“…Some of the most common surgical procedures performed for this condition are open reduction internal fixation (ORIF) and close reduction with percutaneous pinning (CRPP). 2,5 The ideal treatment for supracondylar humerus fractures is, according to many authors, closed reduction and percutaneous pin- ning. As the increasing use of CRPP for this pathology, it has also been considered to be the best approach due to avoidance of high expense during the hospital stay, delayed bone union, and some complications caused by the open reduction.…”