Ismaili Granit, Mahmoud Elsiddig, O' Toole Pat
Children's Health Ireland at Crumlin, Cooley Rd, Crumlin, Dublin D12 N512, Ireland.
Omdurman Islamic University, Khartoum, Sudan.
Int J Surg Case Rep. 2022 May;94:107079. doi: 10.1016/j.ijscr.2022.107079. Epub 2022 Apr 13.
A paediatric floating elbow involves fractures of the supracondylar region of the humerus with ipsilateral fracture of the forearm bones. A floating elbow is very uncommon with an incidence of 3 to 13% of all supracondylar fractures. A concomitant supracondylar and Monteggia fracture is extremely rare with only six cases reported in the literature.
We present the unusual case of an eight-year-old girl with a concomitant ipsilateral supracondylar humerus fracture and open Monteggia fracture. Physical examination showed a neurovascularly intact limb. Surgical management was carried out in the form of closed and open reduction, percutaneous pinning using Kirschner (K) wires and Titanium Elastic Nails (TENs), and wound washout and debridement of the open lesion. The patient developed pin site infection six weeks post operation and subsequently underwent surgery for removal of pins. She was later followed up with normal radiographic and physical examination findings.
The complexity of these fractures can lead to debilitating complications if proper management is not initiated. It is imperative that neurovascular and motor function be assessed in great detail and early surgical fixation be carried out in order to prevent these complications.
A paediatric floating elbow is a rare surgical emergency. Although no guidelines for the management of these fractures exist, we recommend surgical management in a step-by-step approach be used over conservative management. We also stress the importance of regular follow up to address any post operative complications that may arise such as the one in our case.
小儿浮动肘是指肱骨髁上区域骨折合并同侧前臂骨骨折。浮动肘非常少见，在所有髁上骨折中发生率为3%至13%。肱骨髁上骨折合并孟氏骨折极为罕见，文献中仅报道过6例。
我们报告一例不寻常的8岁女童病例，其患有同侧肱骨髁上骨折合并开放性孟氏骨折。体格检查显示肢体神经血管功能完好。手术治疗采用闭合复位与切开复位、克氏针和钛弹性髓内钉经皮穿针固定，以及对开放伤口进行冲洗和清创。患者术后六周出现针道感染，随后接受了拔针手术。她后来接受随访，影像学和体格检查结果均正常。
如果处理不当，这些骨折的复杂性可能导致严重并发症。必须详细评估神经血管和运动功能，并尽早进行手术固定以预防这些并发症。
小儿浮动肘是一种罕见的外科急症。尽管目前尚无此类骨折的治疗指南，但我们建议采用分步手术治疗而非保守治疗。我们还强调定期随访的重要性，以处理可能出现的任何术后并发症，如我们病例中的情况。
