ArticleJournal of the Pediatric Orthopaedic Society of North America2025
Hold that K Wire! Fixing Nondisplaced Distal Forearm Fractures in Pediatric Floating Elbow Injuries is Unnecessary.
Article in Journal of the Pediatric Orthopaedic Society of North America, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Floating elbow injuries are uncommon, combined injuries in children involving a supracondylar humerus fracture and a distal fracture of the forearm. Orthopaedic dogma has suggested that a more aggressive approach to the distal fracture is necessary due to the potential risk of acute compartment syndrome. Our group recently showed that the rate of compartment syndrome is less than one percent. As such, we hypothesized that concomitant nondisplaced distal forearm fractures managed with operative fixation would result in similar outcomes compared to nonsurgical treatment. Methods: A multicenter retrospective database was queried for pediatric patients who presented with floating elbow injuries, defined as a supracondylar humerus fracture with a concomitant nondisplaced distal forearm fracture (AO OTA-23-M/2.1), between 2014 and 2019. Patient demographics, injury characteristics, treatment course, and outcomes were evaluated. Patients were compared based on the management strategy of the nondisplaced distal forearm fracture. Results: A total of 102 patients (of the 454 patients in the database) met inclusion criteria, of which 26 (25.4%) underwent operative fixation, with an overall median follow-up of 2.2 months. With respect to distal fracture characteristics, there was no increased incidence of internal fixation of the forearm fracture in patients with a displaced supracondylar fracture (types 3 and 4) ( Conclusion: While the rate of return to full activity at a median of 2.2 months was higher in the noninternal fixation group, other outcomes, including functional recovery, symptoms, complications, and reoperation rates, were similar between the two cohorts. Key Concepts: (1)Floating elbows are defined as a supracondylar humerus fracture paired with a distal both-bone or forearm fracture.(2)In the past, this injury was thought to result in a high rate of compartment syndrome, though current studies refute that.(3)An aggressive approach with the distal fracture may not be warranted in all cases, and closed treatment is acceptable in nondisplaced fractures. Level of Evidence: III.
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