Clin Orthop Surg.  2016 Sep;8(3):345-348. 10.4055/cios.2016.8.3.345.

The Floating Upper Limb: Multiple Injuries Involving Ipsilateral, Proximal, Humeral, Supracondylar, and Distal Radial Limb

• Manaan Q
• Bashir A
• Zahoor A
• Mokhdomi T
• Danish Q

• KMID: 2374284
• DOI: http://doi.org/10.4055/cios.2016.8.3.345

Abstract

Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation.

Keyword

Humeral fractures; Multiple trauma; Kirschner wires

MeSH Terms

Accidental Falls
*Bone Wires
Child
Fracture Fixation
Humans
*Humeral Fractures
Male
Multiple Trauma
Radiography
*Radius Fractures
*Upper Extremity/diagnostic imaging/injuries/surgery

Figure

• 

  Fig. 1 Floating upper limb. X-rays showing injury of the ipsilateral humeral (A), supracondylar (B), and distal radial limb (C; 7 hours post injury). Each arrow indicates the point of injury.

• 

  Fig. 2 X-rays showing reunion of the limb at 6 weeks after surgery in the ipsilateral humeral (A), supracondylar (B), and distal radial limb (C). Each arrow indicates the point of injury.

• 

  Fig. 3 Final follow-up X-rays showing no observable deformity of the limb at 6 months after discharge. (A) Ipsilateral humerus. (B) Distal radial limb. (C) Supracondylar limb.

Reference

1. Stanitski CL, Micheli LJ. Simultaneous ipsilateral fractures of the arm and forearm in children. Clin Orthop Relat Res. 1980; (153):218–222.

2. Harrington P, Sharif I, Fogarty EE, Dowling FE, Moore DP. Management of the floating elbow injury in children: simultaneous ipsilateral fractures of the elbow and forearm. Arch Orthop Trauma Surg. 2000; 120(3-4):205–208.

3. Guven M, Akman B, Kormaz T, Poyanli O, Altintas F. "Floating arm" injury in a child with fractures of the proximal and distal parts of the humerus: a case report. J Med Case Rep. 2009; 3:9287.

4. Gul A, Sambandam S. Ipsilateral proximal and flexion supracondylar humerus fracture with an associated olecranon fracture in a 4-year-old child: a case report. Eur J Orthop Surg Traumatol. 2006; 16(3):237–239.

5. James P, Heinrich SD. Ipsilateral proximal metaphyseal and flexion supracondylar humerus fractures with an associated olecranon avulsion fracture. Orthopedics. 1991; 14(6):713–716.

6. Parmaksizoglu AS, Ozkaya U, Bilgili F, Sayin E, Kabukcuoglu Y. Closed reduction of the pediatric supracondylar humerus fractures: the "joystick" method. Arch Orthop Trauma Surg. 2009; 129(9):1225–1231.