The floating elbow: uncommon association

¹Orthopedic Trauma Service I, Military Training Hospital Mohamed V, Rabat, Morocco

^&Corresponding author
Ayoub Bouya, Orthopedic Trauma Service I, Military Training Hospital Mohamed V, Rabat, Morocco

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The floating elbow is a term first used in 1980 by Stanitski and Micheli. It is an uncommon entity in adults and corresponds to a humerus fracture associated with a homolateral fracture of one or both forearm bones. A 69-year-old female with type 2 diabetes under diet, admitted to the emergency following a fall. She complained of pain and functional impotence in her right upper limb. Motion attempts of the shoulder and elbow were painful. The neurovascular exam was normal. X-rays showed a proximal humerus fracture (Duparc 2) associated with a homolateral olecranon fracture (A,B). The wrist X-ray was normal. This association was classified S3 A3 O0 according to the Agarwal and Chadha Universal Classification of floating trauma. A posterior approach of elbow allowed both fixations. The gesture consisted of olecranon fixation by tension band wiring followed by humerus fixation by Hackethal intramedullary nailing (C,D). A posterior elbow splint was kept for 15 days. Passive functional rehabilitation began in the 2^nd week with elbow motion on extension flexion followed in the 4^th week by abduction and external rotation motion of the shoulder. After 5 months' follow-up, the patient retained an elbow extension deficit of 10 and a shoulder abduction of 120 without impacting her quality of life.

Figure 1: (A,B,C,D) floating elbow