Management of floating elbow injuries secondary to side swipe injury

Abstract

Floating elbow injuries, defined as simultaneous fractures of the humerus and forearm, pose challenges due to their rarity and severity. Management involves complex evaluations and interventions, with controversies in optimal timing and techniques. Side swipe injuries, typical in low-income countries with high road accidents, contribute to this injury pattern.

A retrospective study (January 2020–December 2023) involving 15 patients with side swipe-induced floating elbow injuries was conducted. Data encompassed demographics, surgical approaches, techniques, post-operative care, and outcomes.

The mean patient age was 34.7 years, predominantly male (80%). The most frequent injuries were humeral shaft fractures (53.3%). Surgical timing averaged 8.3 hours post-injury, employing varied techniques (e.g., nailing, plating) with a mean surgery duration of 2.5 hours. At 18 months follow-up, outcomes revealed satisfactory pain scores (mean: 2.7), moderate range of motion (mean: 101.3 degrees), and acceptable functional scores (MEPS: 81.7, DASH: 18.3). Complications (nonunion, malunion, delayed union, hardware failure, ossification, stiffness) affected 53.3% of patients, with revision surgeries necessary for some cases. Patient satisfaction rated as satisfied or very satisfied by 73.3% of patients.

The research aligns with previous findings, showing a higher incidence in young to middle-aged males and a predominance of right-sided injuries. The most common fracture types (humeral shaft, Monteggia) and complications (nonunion, malunion, delayed union) are consistent with existing literature. Surgical approaches and techniques varied, but nailing for humerus and plating for forearm were most common, aligning with established practices. Post-operative complications were frequent, reflecting the severity of these injuries. Despite limitations like small sample size and short follow-up, the study supports the effectiveness of timely surgery and rehabilitation in achieving satisfactory outcomes, echoing previous research. Further studies with larger cohorts and longer follow-ups are needed to validate and expand upon these findings.

The research focused on 15 cases of floating elbow injuries from side swipe accidents, outlining the challenges and treatments. Despite complexities in managing these rare injuries, surgeries tailored to fracture types showed promise. Complications like nonunion and stiffness persisted, but timely surgery and rehabilitation led to satisfactory recoveries and high patient satisfaction. Larger, longer studies are needed to refine treatments for better outcomes.