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A review of outcomes in 18 patients with floating elbow
Harrison B Solomon1, Mary Zadnik, W Andrew Eglseder
1Department of Orthopaedic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA.
Objective:
To assess functional outcomes and predictors of success in floating elbow injuries.
Design:
Retrospective clinical review.
Setting:
Level 1 trauma center.
Patients:
Eighteen patients with floating elbow injuries seen at the trauma center from 1995-2001.
Intervention:
All injuries were managed surgically. Each forearm fracture was managed with open reduction and internal fixation. Humerus fractures were managed with either open reduction and internal fixation or intramedullary nail. Definitive fixation was performed in all cases within 48 hours of arrival at the trauma center.
Main Outcome Measurements:
Eighteen patients were available for follow-up at a minimum of 1 year and consented to enroll in the study. Each patient was evaluated with a standardized elbow score based on a 100-point scale. These scores were correlated with injury features including age, severity of fracture (AO classification), open fractures, nerve injuries, vascular injuries, type of fixation on the humerus, and the presence of concomitant intra-articular elbow injuries.
Results:
The average elbow score was 68/100. Outcomes were divided into two groups. Eleven patients had a score greater than 75 (group I), with a mean score of 83, and were considered to have a good or excellent result. Seven patients had a score less than 75 (group II), with a mean score of 45, and were considered to have a satisfactory or poor result. The distribution of outcomes revealed two statistically distinct clusters. Additionally, there was a significantly higher incidence of nerve injuries in group 2 compared with group 1.
Conclusions:
Functional outcomes in floating elbow injuries tend to cluster into two groups-patients with good or excellent results and patients with poor results. Patients with associated nerve injuries have lower functional outcomes at a minimum of 1-year follow-up.