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Topic:

Floating Elbow

Issue:

Elbow

Category:

Trauma

Title:

Pediatric Floating Elbows … What Is All the Fuss About? A Multicenter Perspective

Author:

Zheng, Jenny L. BS; CORTICES Collaborators

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p e232-e237, DOI: 10.1097/BPO.0000000000002593

Level Of Evidence:

IV

# of Patients:

454

Study Type:

Retrospective cohort study

Location:

15 institutions

Summary:

This study evaluates treatment approaches, outcomes, and the incidence of pediatric acute compartment syndrome (PACS) in floating elbow injuries in children.

Methods:

Retrospective review of pediatric patients (2014-2019) with floating elbow injuries. Injury severity classified by the Children’s Orthopaedic Trauma and Infection Consortium for Evidence-Based Studies (COTI-CESS). Patient demographics, injury characteristics, treatment, and outcomes analyzed.

Exclusions:

Not specified

Results:

Demographics: 51% male, median age 6.8 years at injury. Injury Classifications: Class 1 (Gartland 1 supracondylar fracture): least severe. Class 2 (Gartland 2 supracondylar fracture). Class 3 (Gartland 3 or 4, or t-condylar fracture): most severe. Nerve Injuries: 20% of patients presented with nerve injuries, most common in class 3 injuries (P<0.001). Only 3.1% had persistent nerve injuries at follow-up. Vascular Injuries: 2.9% of patients presented without a palpable or dopplerable pulse, all had class 3 injuries. PACS: Only 1 case (0.2%) of PACS was observed, despite the presence of displaced proximal and distal fractures. Treatment: Closed treatment for nondisplaced distal fractures. Proximal fracture open reduction rate: 7.7%. Outcomes: 70% had good/excellent outcomes (Modified Flynn). More severe injuries had worse outcomes (P=0.030).

Conclusions:

Pediatric floating elbow injuries rarely lead to PACS (0.2%). Nerve and vascular injuries were comparable to isolated fractures and were related to fracture displacement. The COTI-CESS classification system effectively predicted outcomes for pediatric floating elbow injuries.

Relevance:

Limitations:

Perspective:

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