Analysis of complications after a floating elbow injury

  • Verónica Jiménez-DíazEmail author
  • Ismael Auñón-Martín
  • Carlos Olaya-González
  • Miguel Aroca-Peinado
  • David Cecilia-López
  • Pedro Caba-Doussoux
Original Article • ELBOW - TRAUMA



The aim of the present study is to analyse complications after a floating elbow injury, attempting to establish which of them act as a poor prognosis factor regarding clinical and functional results.

Materials and methods

Twenty-three patients who suffered a floating elbow injury, treated at our institution from 2004 to 2013, were retrospectively reviewed. Patients were divided into four groups depending on the type of injury. An analysis of demographic data, associated injuries, treatment options and complications was carried out. Clinical evaluation was made by a conventional goniometer, testing flexo-extension and prono-supination ranges. For functional evaluation, the Mayo Elbow Performance Score was employed. Association between radioulnar synostosis, articular surface disruption, nerve injury and clinical and functional results was analysed.


Patients with radioulnar synostosis had worse results in functional evaluation than patients without it (56.6 vs. 75); this difference was statistically significant (p = 0.05). Regarding intra-articular extension, we found statistical association with worse results in functional evaluation (p = 0.018); however, nerve palsy does not seem to influence functional results.


Radioulnar synostosis and intra-articular extension of the injury are poor prognosis factor in floating elbow.


Floating elbow Complications Prognosis Radioulnar synostosis 


Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest in relation to the development of this work.

Ethical approval

Approval was gained from the audit committee according to the regulation of our institution.

Informed consent

Informed consent was obtained from all participants included in the study.


  1. 1.
    Stanitski CL, Micheli LJ (1980) Simultaneous ipsilateral fractures of the arm and forearm in children. Clin Orthop 153:218–222Google Scholar
  2. 2.
    Rogers JF, Bennet JB, Tullos HS (1984) Management of concomitant ipsilateral fractures of the humerus and forearm. J Bone Joint Surg Am 66:552–556CrossRefPubMedGoogle Scholar
  3. 3.
    Viegas SF, William G, Riley S (1989) Floating dislocated elbow: case report and review of the literature. J Trauma 29(6):886–888CrossRefPubMedGoogle Scholar
  4. 4.
    Sarup S, Bryant PA (1997) Ipsilateral humeral shaft and Galeazzi fractures with a posterolateral dislocation of the elbow: “Floating dislocated elbow”. J Trauma 43(2):349–352CrossRefPubMedGoogle Scholar
  5. 5.
    De Carli P, Boretto JG, Bourgeois WO, Gallucci GL (2006) Floating dislocated elbow: a variant with articular fracture of the humerus. J Trauma 60:421–422CrossRefPubMedGoogle Scholar
  6. 6.
    Galasso O, Mariconda M, Gasparini G (2011) Repeated floating elbow injury after high-energy trauma. Strat Traum Limb Recon 6:33–37CrossRefGoogle Scholar
  7. 7.
    Jockel CR, Gardenal RM, Chen NC, Golden RD, Jupiter JB, Capomassi M (2013) Intermediate-term outcomes for floating elbow and floating elbow variant injuries. J Shoulder Elbow Surg 22:280–285CrossRefPubMedGoogle Scholar
  8. 8.
    Ditsios K, Boutsiadis A, Papadopoulos P, Karataglis D, Givissis P, Hatzokos I, Christodoulou A (2013) Floating elbow injuries in adults: prognosis factors affecting clinical outcomes. J Shoulder Elbow Surg 22:74–80CrossRefPubMedGoogle Scholar
  9. 9.
    Lerner A, Stahl S, Stein H (2000) Hybrid external fixation in high-energy elbow fractures: a modular system with a promising future. J Trauma 49(6):1017–1022CrossRefPubMedGoogle Scholar
  10. 10.
    Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ (2012) Management of humeral shaft fractures. J Am Acad Orthop Surg 20(7):423–433CrossRefPubMedGoogle Scholar
  11. 11.
    Bisinella G, Bellon N (2015) Floating elbow in a polytrauma patient: timing and surgical strategy. Injury 46(Suppl 7):S20–S22CrossRefPubMedGoogle Scholar
  12. 12.
    Pierce RO, Hodorski DF (1979) Fractures of the humerus, radius and ulna in the same extremity. J Trauma 19:182–185CrossRefPubMedGoogle Scholar
  13. 13.
    Yokoyama K, Itoman M, Kobayashi A, Shindo M, Futami T (1998) Functional outcomes of “floating elbow” injuries in adult patients. J Orthop Trauma 12:284–290CrossRefPubMedGoogle Scholar
  14. 14.
    Solomon HB, Zadnik M, Eglseder WA (2003) A review of outcomes in 18 patients with floating elbow. J Orthop Trauma 17:563–570CrossRefPubMedGoogle Scholar
  15. 15.
    El Ibrahimi A, Shimi M, Daoudi A, Elmrini A (2012) Le coude flottant: étude rétrospective et revue de la littérature. Chi main 31:350–354CrossRefGoogle Scholar
  16. 16.
    Bergeron SG, Desy NM, Bernstein M, Harvey EJ (2012) Management of posttraumatic radioulnar synostosis. J Am Acad Orthop Surg 20:450–458CrossRefPubMedGoogle Scholar
  17. 17.
    Anderson LD, Sisk D, Tooms RE, Park WI III (1975) Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am 57(3):287–297CrossRefPubMedGoogle Scholar
  18. 18.
    Bauer G, Arand M, Mutschler W (1991) Post-traumatic radioulnar synostosis after forearm fracture osteosynthesis. Arch Orthop Trauma Surg 110(3):142–145CrossRefPubMedGoogle Scholar
  19. 19.
    Garland DE, Dowling V (1983) Forearm fractures in the head-injured adult. Clin Orthop Relat Res 176:190–196Google Scholar
  20. 20.
    Vince KG, Miller JE (1987) Cross-union complicating fracture of the forearm: part I. Adults. J Bone Joint Surg Am 69(5):640–653CrossRefPubMedGoogle Scholar
  21. 21.
    Jupiter JB, Ring D (1998) Operative treatment of post-traumatic proximal radioulnar synostosis. J Bone Joint Surg Am 80(2):248–257CrossRefPubMedGoogle Scholar
  22. 22.
    Fernández DL, Joneschild E (2004) “Wrap around” pedicled muscle flaps for the treatment of recurrent forearm synostosis. Tech Hand Up Extrem Surg 8(2):102–109CrossRefPubMedGoogle Scholar
  23. 23.
    Bell SN, Benger D (1999) Management of radioulnar synostosis with mobilization, anconeus interposition, and a forearm rotation assist splint. J Shoulder Elbow Surg 8(6):621–624CrossRefPubMedGoogle Scholar
  24. 24.
    Kaminemi S, Maritz NG, Morrey BF (2002) Proximal radial resection for posttraumatic radioulnar synostosis: a new technique to improve forearm rotation. J Bone Joint Surg Am 84(5):745–751CrossRefGoogle Scholar
  25. 25.
    Failla JM, Amadio PC, Morrey BF (1979) Post-traumatic proximal radio-ulnar synostosis: results of surgical treatment. J Bone Joint Surg Am 71(8):1208–1213CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  1. 1.Hospital 12 de OctubreMadridSpain

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