title: Forearm Fixation is Not Necessary in the Treatment of Pediatric Floating Elbow.
abstract: BACKGROUND
  Ipsilateral supracondylar humerus and forearm fractures in the pediatric population are an uncommon injury associated with high-energy trauma. Current literature suggests a high rate of compartmental syndrome with this fracture pattern and recommends surgical stabilization of both injuries. We investigate whether surgical treatment of the supracondylar fracture with closed reduction of the forearm fracture and placement into a noncircumferential cast may be an appropriate treatment.
  
  
  METHODS
  Retrospective clinical and radiographic review of 47 patients (22 male, 25 female; mean age 6 y) with modified Gartland type 2 or type 3 supracondylar humerus fracture requiring surgical stabilization and an ipsilateral forearm fracture from a single institution over 78 months.
  
  
  RESULTS
  Forty-seven pediatric "floating elbow" cases that had operative management of the supracondylar fracture were identified. A total of 21/47 (45%) had displaced forearm fractures that required closed manipulation. Of these, 17/21 (81%) underwent closed reduction of the displaced forearm fracture(s) and were placed into a noncircumferential cast or splint. No patients lost reduction or required remanipulation of either fracture. No patients developed signs of elevated compartment pressures. All patients went on to radiographic union without secondary procedures.
  
  
  CONCLUSIONS
  We demonstrate that a supracondylar humerus fracture with an ipsilateral forearm fracture can be safely managed with operative stabilization of the supracondylar humerus fracture alone. Simultaneous closed reduction of the ipsilateral displaced forearm fracture and use of noncircumferential immobilization postoperatively is safe and was not associated with the development of elevated compartment pressures or need for remanipulation. Previous studies that relate a high rate of compartment syndrome with this injury pattern may be misguided, as method of postoperative immobilization may be a more significant factor in the development of elevated compartment pressures than the injury pattern.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington Medical Center.|Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle WA.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Blumberg
authors.affiliation: University of Washington School of Medicine.
authors.forename: Prashoban
authors.initials: P
authors.lastname: Bremjit
authors.affiliation: Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle WA.
authors.forename: Viviana
authors.initials: V
authors.lastname: Bompadre
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington Medical Center.|Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle WA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Steinman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000070628:Closed Fracture Reduction / Q000379:methods*; D003161:Compartment Syndromes / Q000517:prevention & control; D005260:Female; D005543:Forearm Injuries / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D013165:Splints; D016896:Treatment Outcome; D000092464:Elbow Injuries