title: Functional outcomes of "floating elbow" injuries in adult patients.
abstract: OBJECTIVE
  To assess elbow function, complications, and problems of floating elbow fractures in adults receiving surgical treatment.
  
  
  METHODS
  Retrospective clinical review.
  
  
  METHODS
  Level I trauma center in Kanagawa, Japan.
  
  
  METHODS
  Fourteen patients with fifteen floating elbow injuries, excluding one immediate amputation, seen at the Kitasato University Hospital from January 1, 1984, to April 30, 1995.
  
  
  METHODS
  All fractures were managed surgically by various methods. In ten cases, the humeral and forearm fractures were treated simultaneously with immediate fixation. In three cases, both the humeral and forearm fractures were treated with delayed fixation on Day 1, 4, or 7. In the remaining two cases, the open forearm fracture was managed with immediate fixation and the humerus fracture with delayed fixation on Day 10 or 25.
  
  
  METHODS
  All subjects underwent standardized elbow evaluations, and results were compared with an elbow score based on a 100-point scale. The parameters evaluated were pain, motion, elbow and grip strength, and function during daily activities. Complications such as infections, nonunions, malunions, and refractures were investigated.
  
  
  RESULTS
  Mean follow-up was forty-three months (range 13 to 112 months). At final follow-up, the mean elbow function score was 79 points, with 67 percent (ten of fifteen) of the subjects having good or excellent results. The functional outcome did not correlate with the Injury Severity Score of the individual patients, the existence of open injuries or neurovascular injuries, or the timing of surgery. There were one deep infection, two nonunions of the humerus, two nonunions of the forearm, one varus deformity of the humerus, and one forearm refracture.
  
  
  CONCLUSIONS
  Based on the present data, we could not clarify the factors influencing the final functional outcome after floating elbow injury. These injuries, however, potentially have many complications, such as infection or nonunion, especially when there is associated brachial plexus injury. We consider that floating elbow injuries are severe injuries and that surgical stabilization is needed; beyond that, there are no specific forms of surgical treatment to reliably guarantee excellent results.
authors.affiliation: Department of Orthopedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yokoyama
authors.forename: M
authors.initials: M
authors.lastname: Itoman
authors.forename: A
authors.initials: A
authors.lastname: Kobayashi
authors.forename: M
authors.initials: M
authors.lastname: Shindo
authors.forename: T
authors.initials: T
authors.lastname: Futami
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D005260:Female; D005543:Forearm Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome