Comparison of surgically treated floating elbow injuries and supracondylar humeral fractures in children.

OBJECTIVES

Floating elbow is a rare injury type in pediatric fractures. This study compared the differences in injury mechanisms, treatment modalities, complications and prognosis between floating elbow injury and supracondylar humerus fractures (SHF) in children in a surgically treated cohort.

METHODS

The retrospective analysis included patients with floating elbow and SHF treated at our hospital between May 2016 and May 2023. Sex, age, body mass index (BMI), mechanism of injury, affected limb, fracture displacement, presence of neurovascularinjury, type of injury, Gartland classification, and acute compartment syndrome (ACS) were analyzed. Elbow function was evaluated using the Mayo Elbow Performance Score (MEPS). ACS was defined by clinical criteria including pain, paresthesia, and/or compartment pressure > 30 mmHg.

RESULTS

A total of 113 children were enrolled, including 27 in the floating elbow group (22 males, 5 females, median age 8 years [IQR 6-11 years]), and 86 in the SHF group (58 males, 28 females, median age 8 years [IQR 5-10 years]). Mechanism of injury (p = 0.001), fracture type (p = 0.003), and preoperative nerve injury (p = 0.001) differed significantly between the two groups. ACS incidence differed significantly between open and closed fractures in the floating elbow group (p = 0.028); however, this finding is based on a small number of events.

CONCLUSION

In this surgically treated cohort, we did not detect statistically significant differences in elbow function outcomes between children with floating elbow and those with isolated SHF. Open fractures were associated with a higher incidence of ACS in the floating elbow group compared with closed fractures, although the number of events was small (p = 0.028). Larger studies are needed to confirm equivalence or identify clinically meaningful differences.

LEVEL OF EVIDENCE: III.