FUNCTIONAL OUTCOMES OF FLOATING ELBOW INJURIES IN ADULT PATIENTS

Objectives: To assess elbow function, complications, and problems of f loating elbow fractures in adults receiving surgical treatment. Design : Retrospective clinical review. Setting: Level 1 trauma center in Kan agawa, Japan. Patients: Fourteen patients with fifteen floating elbow injuries, excluding one immediate amputation, seen at the Kitasato Uni versity Hospital from January 1, 1984, to April 30, 1995. Intervention : All fractures were managed surgically by various methods. In ten cas es, the humeral and forearm fractures were treated simultaneously with immediate fixation. In three cases, both the humeral and forearm frac tures were treated with delayed fixation on Day 1, 4, or 7. In the rem aining two cases, the open forearm fracture was managed with immediate fixation and the humerus fracture with delayed fixation on Day 10 or 25. Main Outcome Measurements: All subjects underwent standardized elb ow evaluations, and results were compared with an elbow score based on a 100-point scale. The parameters evaluated were pain, motion, elbow and grip strength, and function during daily activities. Complications such as infections, nonunions, malunions, and refractures were invest igated. Results: Mean follow-up was forty-three months (range 13 to 11 2 months). At final follow-up, the mean elbow function score was 79 po ints, with 67 percent (ten of fifteen) of the subjects having good or excellent results. The functional outcome did not correlate with the I njury Severity Score of the individual patients, the existence of open injuries or neurovascular injuries, or the timing of surgery. There w ere one deep infection, two nonunions of the humerus, two nonunions of the forearm, one varus deformity of the humerus, and one forearm refr acture. Conclusion: Based on the present data, we could not clarify th e factors influencing the final functional outcome after floating elbo w injury. These injuries, however, potentially have many complications , such as infection or nonunion, especially when there is associated b rachial plexus injury. We consider that floating elbow injuries are se vere injuries and that surgical stabilization is needed; beyond that, there are no specific forms of surgical treatment to reliably guarante e excellent results.