Yokoyama K, Itoman M, Kobayashi A, Shindo M, Futami T
Department of Orthopedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
J Orthop Trauma. 1998 May;12(4):284-90. doi: 10.1097/00005131-199805000-00012.
To assess elbow function, complications, and problems of floating elbow fractures in adults receiving surgical treatment.
Retrospective clinical review.
Level I trauma center in Kanagawa, Japan.
Fourteen patients with fifteen floating elbow injuries, excluding one immediate amputation, seen at the Kitasato University Hospital from January 1, 1984, to April 30, 1995.
All fractures were managed surgically by various methods. In ten cases, the humeral and forearm fractures were treated simultaneously with immediate fixation. In three cases, both the humeral and forearm fractures were treated with delayed fixation on Day 1, 4, or 7. In the remaining two cases, the open forearm fracture was managed with immediate fixation and the humerus fracture with delayed fixation on Day 10 or 25.
All subjects underwent standardized elbow evaluations, and results were compared with an elbow score based on a 100-point scale. The parameters evaluated were pain, motion, elbow and grip strength, and function during daily activities. Complications such as infections, nonunions, malunions, and refractures were investigated.
Mean follow-up was forty-three months (range 13 to 112 months). At final follow-up, the mean elbow function score was 79 points, with 67 percent (ten of fifteen) of the subjects having good or excellent results. The functional outcome did not correlate with the Injury Severity Score of the individual patients, the existence of open injuries or neurovascular injuries, or the timing of surgery. There were one deep infection, two nonunions of the humerus, two nonunions of the forearm, one varus deformity of the humerus, and one forearm refracture.
Based on the present data, we could not clarify the factors influencing the final functional outcome after floating elbow injury. These injuries, however, potentially have many complications, such as infection or nonunion, especially when there is associated brachial plexus injury. We consider that floating elbow injuries are severe injuries and that surgical stabilization is needed; beyond that, there are no specific forms of surgical treatment to reliably guarantee excellent results.
评估接受手术治疗的成人漂浮肘骨折的肘部功能、并发症及相关问题。
回顾性临床研究。
日本神奈川县的一级创伤中心。
1984年1月1日至1995年4月30日期间在北里大学医院就诊的14例患者共15处漂浮肘损伤，其中1例为即刻截肢患者除外。
所有骨折均采用多种手术方法治疗。10例患者的肱骨和前臂骨折同时进行即刻固定治疗。3例患者的肱骨和前臂骨折分别在第1、4或7天进行延迟固定治疗。其余2例患者，开放性前臂骨折进行即刻固定，肱骨骨折在第10天或25天进行延迟固定。
所有受试者均接受标准化肘部评估，并将结果与基于100分制的肘部评分进行比较。评估的参数包括疼痛、活动度、肘部和握力以及日常活动功能。对感染、骨不连、畸形愈合和再骨折等并发症进行调查。
平均随访43个月（范围13至112个月）。在末次随访时，平均肘部功能评分为79分，67%（15例中的10例）受试者的结果为良好或优秀。功能结局与个体患者的损伤严重程度评分、开放性损伤或神经血管损伤的存在与否或手术时机无关。发生1例深部感染、2例肱骨骨不连、2例前臂骨不连以及1例肱骨内翻畸形和1例前臂再骨折。
基于目前的数据，我们无法阐明影响漂浮肘损伤后最终功能结局的因素。然而，这些损伤可能会引发许多并发症，如感染或骨不连，尤其是在伴有臂丛神经损伤时。我们认为漂浮肘损伤是严重损伤，需要手术稳定；除此之外，没有特定的手术治疗方式能可靠地保证取得优异结果。
