An unprecedented pan-brachial injury: A case report of ipsilateral floating shoulder, floating elbow, and acetabular fracture following a psychosis-induced fall.

INTRODUCTION: High-energy trauma can result in complex orthopedic injury patterns. The "floating shoulder" and "floating elbow" are distinct, severe injuries involving serial fractures of the upper extremity, disrupting adjacent joint function. The simultaneous ipsilateral occurrence of both, further complicated by a pelvic fracture, represents an exceptionally rare and challenging clinical scenario.

CASE PRESENTATION: We present the case of a 45-year-old male with a history of schizophrenia who sustained multiple fractures after a fall from a height during a psychotic episode. He was diagnosed with an ipsilateral left-sided floating shoulder (Neer Type I distal clavicle fracture and a surgical neck of humerus fracture), a floating elbow (open Type I Gustilo-Anderson supracondylar and intercondylar distal humerus fracture with metaphyseal comminution, and fractures of the distal radius and ulna), and a non-displaced anterior column acetabular fracture. This report details the single-session surgical marathon performed hours after admission, which included intramedullary nailing of the humerus, open reduction and internal fixation (ORIF) of the distal humerus, and external fixation of the wrist, alongside non-operative management for the clavicle and acetabulum.

CONCLUSION: This report describes a unique and previously unreported combination of injuries. The patient's successful outcome depended on collaboration between multiple specialties, decisive surgical planning, and a single, extensive operation to stabilize his fractures. The patient's psychiatric condition added a significant layer of complexity to his perioperative care and rehabilitation. To our knowledge, this specific combination of ipsilateral floating shoulder, floating elbow, and acetabular fracture has not been previously reported in the literature.