DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20200733

Floating elbows in adults: epidemiology, clinical presentation, management and prognosis: Brazzaville Teaching Hospital experience

Monka Marius, Ohoya Etsaka Terence Olivier, Massamba Miabaou Didace, Ngatse Oko Albert, Moyikoua Armand

Abstract


Background: The objective of this study was to describe the epidemiological, clinical presentation, management and prognosis of classic floating elbows at the Brazzaville University hospital.     

Methods: This is retrospective descriptive study conducted in the Trauma-Orthopedics Department at Brazzaville University Hospital between January 2013 and December 2018. Four patients meeting the inclusion criteria underwent surgery. Open fractures were classified according to the classification of Gustilo and Anderson. Anatomical evaluation was based on the quality of fracture reduction and bone healing. The functional results were assessed according to the Mayo Clinic score.

Results: The functional results were assessed according to the Mayo Clinic score of the 4 patients in our study, there were 3 men and 1 woman. The average age was 31 (28 and 34). They were all victims of traffic accidents. Three floating elbows were closed and one open at the humeral level with paralysis of the radial nerve. The closed fractures were treated by screwed plates and the open fracture by external fixator. Bone healing was achieved in 3 patients and we observed 1 case of aseptic nonunion of the radius. According to the Mayo Clinic score, 2 patients had a very good functional result, 1 patient an average result and 1 patient a poor result.    

Conclusions: Classic floating elbows are rare and their prognosis remains unpredictable, especially when they involve musculo-cutaneous or neurovascular damages. Their treatment must be surgical in the adult to avoid a prolonged immobilization which may lead to stiffness of the elbow. A multidisciplinary approach should then be taken into consideration. 


Keywords


Floating elbow, Classic, Adult

Full Text:

PDF

References


Stanitski CL, Micheli LJ. Simultaneous ipsilateral fractures of the arm and forearm in children. Clin Orthop Relat Res. 1980;(153):218-22.

Rogers JF, Benett JB, Tullos HS. Management of concomitant ipsilateral fractures of humerus and forearms. J Bone Joint Surg (AM). 1984;66:552-5.

Cho C-H, Min K-K. Classic Floating Elbow in Adults: A Case Series. Clin Shoulder Elbow. 2015;18(1):8-12.

Trigui M, Khemakhem Z, Sallemi J, Bouaziz W, Ellouz Z, Zribi M, et al. Le coude flottant chez l’adulte : aspects cliniques et médicolégaux. J. I.M. Sfax 2018;29:38-46.

Yokoyama K, Itoman M, Kobayashi A, Shindo M, Futami T. Functional outcomes of “floating elbow” injuries in adult patients. J Orthop Trauma. 1998;12(4):284-90.

Anoumou NM, Gogoua D, Assiobo A, Kone B, Fal A, Guedegbe F, et al. Coude flottant et derives: aspects nosologiques et resultats therapeutiques a propos de 7 cases. Rev Cames- serie. 2006;4:13-7.

Gustillo RB, Mendoza RB, William DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24:742-6.

Morrey BF, Adams RA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. J Bone Joint Surg Am. 1992;74:479- 90.

Lamah L, Diakite SK, Kallo OF, Toure M, Diallo MM, Kourouma F, Diallo IG, Diallo I. Coudes Flottants: aspects anatomo-cliniques et al. analyse du traitement. Mali Medical. 2013;28(4):9-12.

Jockel CR, Gardenal RM, Chen NC, Golden RD, Jupiter JB, Capomassi M. Intermediate-term outcomes for floating elbow and floating elbow variant injuries. J Shoulder Elbow. 2013;22(2):280-5.

Harrington P, Sharif I, Fogarty EE, Dowling FE, Moore DP. Management of the floating elbow injury in children. Simultaneous ipsilateral fractures of the elbow and forearm. Acta Orthop Trauma Surg. 2000;120:205-8.