Plate Osteosynthesis for Segmental Forearm Fractures: A Comparison of Outcomes in Floating Elbow and Isolated Forearm
Hyun-Tak Kang1, Soo-Hong Han2, Hong-Je Kang3
1Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Background:
Segmental forearm fractures are challenging to treat due to their instability. A floating elbow, characterized by ipsilateral fractures of both the humerus and forearm, is a rare but severe injury often caused by high-energy trauma and associated with significant soft tissue damage. The objective of this study is to compare the surgical outcomes of plate osteosynthesis in segmental forearm fractures, with and without the concomitant presence of a floating elbow.
Methods:
A total of 35 adult patients who underwent open reduction and internal fixation for segmental forearm fractures between 2010 and 2022 were included in this study. Patients were divided into 2 groups: group 1 (isolated forearm fractures, n = 26) and group 2 (floating elbow, n = 9). Radiological union time, forearm rotational range of motion (ROM), visual analog scale (VAS) scores, and Grace-Eversmann criteria were evaluated.
Results:
All patients achieved bone union without additional procedures. The average union time was 15.0 weeks in group 1 and 17.3 weeks in group 2, with no statistically significant difference observed. However, functional outcomes were significantly worse in group 2, demonstrated by reduced supination (68.9° vs. 78.9°) and pronation (54.4° vs. 71.9°). VAS scores were higher in group 2 (3.4 vs. 1.9), and Grace-Eversmann criteria showed poorer ratings in the floating elbow group. Correlation analysis revealed a significant negative relationship between soft-tissue injury severity (assessed using Injury Severity Score and Gustilo-Anderson classification) and forearm rotational ROM (r = -0.50, p = 0.001; r = -0.58, p = 0.0002), but not with union time.
Conclusions:
In our study, good bone union was achieved through open reduction and plate fixation in forearm segmental fractures, regardless of the presence of a floating elbow. However, functional outcomes were significantly worse in floating elbow cases, likely due to the combined effect of soft-tissue injuries and humeral fractures. This suggests that soft-tissue injuries play a key role in determining clinical outcomes. Therefore, meticulous management of soft tissue injuries, combined with rigid fixation, is essential for optimal outcomes.
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