title: Ipsilateral supracondylar fracture and forearm bone injury in children: a retrospective review of thirty one cases.
abstract: BACKGROUND
  Pediatric supracondylar fracture and forearm bone fracture is common in isolation but combined supracondylar fracture with ipsilateral forearm bone fracture, 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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. 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. 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 had poor result in terms of Flynn criteria in three months follow up.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedics and Traumatology, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal.
authors.forename: D
authors.initials: D
authors.lastname: Dhoju
authors.forename: D
authors.initials: D
authors.lastname: Shrestha
authors.forename: N
authors.initials: N
authors.lastname: Parajuli
authors.forename: G
authors.initials: G
authors.lastname: Dhakal
authors.forename: R
authors.initials: R
authors.lastname: Shrestha
mesh_terms: D000293:Adolescent; D001858:Bone Nails; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005543:Forearm Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D006811:Humerus / Q000293:injuries / Q000601:surgery; D015994:Incidence; D008297:Male; D009390:Nepal / Q000453:epidemiology; D011379:Prognosis; D011859:Radiography; D011884:Radius / Q000293:injuries / Q000601:surgery; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014457:Ulna / Q000293:injuries / Q000601:surgery; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery