title: Floating elbow injuries in adults: prognostic factors affecting clinical outcomes.
abstract: BACKGROUND
  Floating elbow fractures in adults are rare and complex injuries with unpredictable outcomes. The present study was designed to assess our experience, analyze possible compilations and illustrate prognostic factors of the final outcome.
  
  
  METHODS
  Between 2002 and 2009, 19 patients with floating elbow fractures were treated in our department (mean follow-up, 26 months). The fractures were open in 10 patients (52.6%), and concomitant nerve palsy was present in 10 patients. Although the term "floating elbow" refers only to concomitant ipsilateral humeral and forearm shaft fractures, we also included injuries with intra-articular involvement. We categorized the patients into 4 groups: group I (10 patients) included shaft fractures of humerus and forearm, group IIa (5 patients) and IIb (1 patient) included partial intra-articular injuries, and group III (3 patients) involved only intra-articular comminuted fractures of the elbow region.
  
  
  RESULTS
  Fracture healing was observed 14 weeks postoperatively, except in 2 patients, in which elbow arthroplasty was applied, and in 1 with brachial artery injury. Nine patients with nerve neuropraxia recovered 4 months postoperatively, and tendon transfers were necessary in 1 patient. Recovery in patients with nerve palsy was worse than in those without nerve injury (Mayo Elbow Performance Score, 73 vs 88.34; Khalfayan score, 72 vs 88.3). In addition, intra-articular involvement (groups II and III) negatively influenced the final clinical outcome compared with isolated shaft fractures (group I; Mayo Elbow Performance Score, 71.1 vs 88.5; Khalfayan score, 72.67 vs 86.1).
  
  
  CONCLUSIONS
  Although the nature of floating elbow injuries is complex, the presence of nerve injury and intra-articular involvement predispose to worse clinical outcomes.
authors.affiliation: First Orthopaedic Department of Aristotelian University of Thessaloniki, G. Papanikolaou General Hospital, Exohi, Thessaloniki, Greece. kostasditsios@gmail.com
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Ditsios
authors.forename: Achilleas
authors.initials: A
authors.lastname: Boutsiadis
authors.forename: Pericles
authors.initials: P
authors.lastname: Papadopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karataglis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Givissis
authors.forename: Ippokratis
authors.initials: I
authors.lastname: Hatzokos
authors.forename: Anastasios
authors.initials: A
authors.lastname: Christodoulou
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000150:complications* / Q000601:surgery*; D057072:Intra-Articular Fractures / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D011379:Prognosis; D011885:Radius Fractures / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000150:complications* / Q000601:surgery*; D055815:Young Adult; D000092464:Elbow Injuries