The Pediatric Floating Elbow

The pediatric floating elbow involves fractures of the humerus and forearm. Majority of these injuries include supracondylar humerus fractures with ipsilateral forearm fractures. These fractures should be managed with great caution as they often result from higher energy injuries and have increased risks of nerve palsies, open fractures, loss of forearm fracture reduction, and compartment syndrome. Previous literature has advocated for operative fixation of ipsilateral forearm fractures in addition to stabilization of the supracondylar humerus fracture, to allow for noncircumferential immobilization to decrease the risk of compartment syndrome. However, recent studies have questioned the universal need for forearm fixation in patients with these injuries. This paper will discuss the pediatric floating elbow, review the available literature, and describe our technique for managing these injuries.