Floating elbow is a medical term that was first introduced by Stanitski and Micheli to describe an injury in children that involves concomitant fractures of the forearm axis and supracondylar humerus in the same extremity. This medical term has also been extended to include adult patients who suffers from ipsilateral fractures of the humerus and forearm. Floating elbow is usually associated with an elbow dislocated in patients suffering from high impact injuries following a serious incident such as a car crash. The “floating” term is used when the elbow remains dislocated from the hand and shoulder.
The most likely cause of such injury for children is due to a fall on the outstretched arm with the forearm pronated and wrist hyperextended. Direct trauma can also result in this injury. Adult patients suffer from floating elbow largely due to high speed trauma such as an accident or falls from extreme heights.
The most obvious symptom in patients with floating elbow is tremendous pain and an obvious deformity in the affected elbow. There is also a possibility of injuries to the surrounding soft tissues such as the ligaments and tendons and this will depend on the mechanism of injury and severity of pathology.
The severity of injury varies among patients depending on several factors such as the position of the arm and impact of force. The nature of treatment is likewise affected by such factors. Management of floating elbow differs slightly between children and adults. However, the initial management is ultimately provisional immobilisation of the fracture. The injured extremity will be protected by a cast and supported by an arm sling.
Surgical options include either a rigid plate fixation or locked intramedullary nailing of the fracture. Both options will provide stability and a high chance of union. Rigid plate fixation will decrease the downtime and will promote early regaining of the full range of motion in the affected joint. In children however, a closed reduction surgical technique is preferred as it provides the highest chances of union with the least possibility of deformity. A mixture of surgical options is accompanied by post-surgery complications. In rare cases, neurovascular injuries may be initiated by a floating elbow injury although chances are slim. These neurovascular injuries can be in the form of nerve palsy to branchial plexus lesions. Infection following surgery is also a possible factor especially for patients who have open fractures and immediate internal fixation.