Floating elbow injuries in adults: prognostic factors affecting clinical outcomes Konstantinos Ditsios, MD, PhD*, Achilleas Boutsiadis, MD, Pericles Papadopoulos, MD, PhD, Dimitrios Karataglis, MD, PhD, Panagiotis Givissis, MD, PhD, Ippokratis Hatzokos, MD, PhD, Anastasios Christodoulou, MD, PhD First Orthopaedic Department of Aristotelian University of Thessaloniki, ‘‘G. Papanikolaou’’ General Hospital, Exohi, Thessaloniki, Greece 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 depart- ment (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 ipsi- lateral 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 fore- arm, 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 recov- ered 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 influ- enced 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. Level of evidence: Level IV, Case Series, Treatment Study. Ó 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Floating elbow; clinical outcomes; prognostic factors In 1980, Stanitski and Micheli 17 introduced the term ‘‘floating elbow’’ to describe the injury pattern of ipsilateral supracondylar humerus and forearm axis fractures that ‘‘disconnect’’ the elbow from the remaining limb in chil- dren. This description has been extended to adults who The Scientific Council of the ‘‘G. Papanikolaou’’ General Hospital approved this the project (Log No: 1970/7.13.2009). *Reprint requests: Dr Konstantinos Ditsios, General Hospital ‘‘G Papanikolaou,’’ Orthopaedic Department, Exohi, Thessaloniki 57010, Greece. E-mail address: kostasditsios@gmail.com (K. Ditsios). J Shoulder Elbow Surg (2013) 22, 74-80 www.elsevier.com/locate/ymse 1058-2746/$ - see front matter Ó 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. http://dx.doi.org/10.1016/j.jse.2012.09.005