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.
Highlights
Ipsilateral supracondylar humerus and forearm fractures in the pediatric population are an uncommon injury associated with high-energy trauma
Given the severity and rarity of this condition, as well as the scarcity of studies for an optimal management for such injuries, we reviewed our experience regarding the management of the floating elbow injury by early fracture reduction and operative stabilization
Our study included 17 children with completely displaced supracondylar fractures associated with a forearm fracture
Summary
Ipsilateral supracondylar humerus and forearm fractures in the pediatric population are an uncommon injury associated with high-energy trauma. Elbow fracture together with fracture of the ipsilateral forearm represents severe upper limb injury in children.[1] Stanitski and Micheli were the first to coined the term "floating elbow" to describe associations between such injuries in six cases.[2] Such combination injuries are uncommon, with prevalence ranging from two to 13%, and indicate higher-energy fracture.[2,3]. Such injury pattern is thought to have a high.
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