Description
Aim: Typically floating elbow injuries are considered to be the concomitant ipsilateral fracture of the humeral shaft and the forearm. Nowadays the definition has been extended to include the intra-articular fractures of the humerus and the elbow. Our aim is to present the treatment of these complex injuries and the results from a series of 4 patients.
Background: A “floating elbow” type injury which is a concomitant ipsilateral fracture of the humerus and the forearm with an articular disruption requires an anatomic reduction of the fractures, in order to ensure a better range of motion in the elbow without stiffness. Different combinations of those fractures exist, although the ones with the involvement of the elbow joint are extremely rare.
Method: In the period 2019-2020, 4 cases with ipsilateral fractures of the humerus and the elbow, due to high energy trauma, were treated in our clinic. The mean age of patients was 44 (range, 33-69) years, and the mean postoperative follow-up was 15 (range, 12-20) months. The two patients who sustained a distal humeral fracture and the one patient with a subcapital fracture of the proximal humerus underwent open reduction and internal fixation, while the fourth patient with a comminuted fracture of the proximal humerus extending to mid-shaft required a shoulder hemiarthroplasty. The elbow fractures were all comminuted at the olecranon and were treated with an anatomical olecranon plate. One of the patients presented preoperatively with palsy of the radial nerve, which was resolved after the osteosynthesis of the fractures. Firstly the osteosynthesis of the olecranon was performed and then the operation at the humerus.
Results: Radiological signs of fracture healing were evident at 12 (range, 10-14) weeks postoperatively. At the last follow-up, the patients had a satisfactory range of motion in the shoulder (mean anterior flexion 163o, abduction 153o, external rotation 67o), and an average elbow extension deficit of 14o. The largest elbow extension deficit (mean, 17.5o) was measured in the 2 patients with ipsilateral distal humeral fracture. According to the Mayo Elbow Performance Score, the results were found to be very good with a score of 82.
Conclusions: The ipsilateral humerus and elbow fractures are rare and complex fractures, and require good surgical experience. When the fracture of the humerus is located at the distal end it seems to be a negative prognostic factor for the range of motion of the elbow.
