Publication: Ipsilateral Supracondylar Fracture and Forearm Bone Injury in Children: A Retrospective Review of Thirty one Cases
Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Supracondylar fracture and forearm bone fracture in isolation is common
musculoskeletal injury in pediatric age group But combined supracondylar fracture
with ipsilateral forearm bone fracture, also known as floating elbow is not common
injury. The incidence of this association varies between 3% and 13%. Since the
injury is rare and only limited literatures are available, choosing best management
options for floating elbow is challenging.
Method
In retrospective review of 759 consecutive supracondylar fracture managed in
between July 2005 to June 2011, children with combined supracondylar fracture
with forearm bone injuries were identified and their demographic profiles, mode
of injury, fracture types, treatment procedures, outcome and complications were
analyzed.
Result
Thirty one patients (mean age 8.91 yrs, range 2-14 yrs; male 26; left side 18) had
combined supracondylar fracture and ipsilateral forearm bone injury including
four open fractures. There were 20 (64.51%) Gartland type III (13 type IIIA and 7
type III B), seven (22.58 %) type II, three (9.67 %) type I and one (3.22 %) flexion
type supracondylar fracture. Nine patients had distal radius fracture, six had distal
third both bone fracture, three had distal ulna fracture, two had mid shaft both
bone injury and one with segmental ulna with distal radius fracture. There were
Monteggia fracture dislocation, proximal ulna fracture, olecranon process fracture,
undisplaced radial head fracture of one each and two undisplaced coronoid
process fracture. Type I supracondylar fracture with undisplaced forearm were
treated with closed reduction and long arm back slab or long arm cast. Displaced
forearm fracture required closed reduction and fixation with Kirschner wires or
intramedullary nailing. Nineteen patients with Gartland type III fracture underwent
operative intervention. Among them nine had closed reduction and K wire fixation
for both supracondylar fracture and forearm bone injury. One patient with closed
reduction and long arm cast application for both type III supracondylar fracture
and distal third radius fracture developed impending compartment syndrome
and required splitting of cast, remanipulation and Kirschner wire fixation. There
were three radial nerve, one ulnar nerve and one median nerve injury and two
postoperative ulnar nerve palsy. Three patients had pin tract related complications.
Among type III, 16 (80%) patients had good to excellent, two had fair and one gad
poor result in terms of Flynn’s criteria in three months follow up
Conclusion
Displaced supracondylar fracture with ipsilateral displaced forearm bone injuries
need early operative management in the form of closed reduction and percutaneous
pinning which provides not only stable fixation but also allows close observation for
early sign and symptom of development of any compartment syndrome.
KEYWORDS
Floating elbow; Forearm bone injury; Ipsilateral fracture; Supracondylar fracture
Description
Dhoju D, Shrestha D, Parajuli N, Dhakal G, Shrestha R
Department of Orthopaedics and traumatology Dhulikhel Hospital-Kathmandu University Hospital Dhulikhel, Nepal