Pediatric floating elbow

A retrospective review of 16 patients with floating elbow injuries over a 9 -year period at a tertiary care children's hospital confirms that these inj uries are associated with substantial swelling and the potential to develop compartment syndrome, particularly when circumferential cast immobilizatio n is used. Among 10 patients in whom the forearm was treated with closed re duction and plaster immobilization, a compartment syndrome developed in 2, and 4 patients had incipient compartment syndrome that responded to splitti ng of the: cast; 3 of these subsequently required remanipulation of the dis tal radius. One patient with compartment syndrome had Volkmann ischemic con tracture. Six patients underwent stabilization of both the distal humeral a nd forearm fractures with percutaneously inserted Kirschner wires, thereby allowing postreduction immobilization in a split cast. None of these patien ts had problems with excessive swelling or compartment syndrome. Percutaneo us Kirschner wire fixation of both the humeral and forearm fractures in ped iatric flouting elbow injuries allows noncircumferential immobilization, th ereby reducing the risk of compartment syndrome.