TraumaForearm Fixation is Not Necessary in the Treatment of Pediatric Floating ElbowBlumberg, Todd J. MD*,†; Bremjit, Prashoban MD‡; Bompadre, Viviana PhD†; Steinman, Suzanne MD*,†Author Information *Department of Orthopaedics and Sports Medicine, University of Washington Medical Center ‡University of Washington School of Medicine †Department of Orthopaedics and Sports Medicine, Seattle Children’s Hospital, Seattle WA None of the authors received financial support for this study. The authors declare no conflicts of interest. Reprints: Todd J. Blumberg, MD, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 Pacific Avenue NE, P.O. Box 356500, Seattle WA 98195. E-mail: firstname.lastname@example.org. Journal of Pediatric Orthopaedics: February 2018 - Volume 38 - Issue 2 - p 82-87 doi: 10.1097/BPO.0000000000000774 Buy Metrics Abstract Background: Ipsilateral supracondylar humerus and forearm fractures in the pediatric population are an uncommon injury associated with high-energy trauma. Current literature suggests a high rate of compartmental syndrome with this fracture pattern and recommends surgical stabilization of both injuries. We investigate whether surgical treatment of the supracondylar fracture with closed reduction of the forearm fracture and placement into a noncircumferential cast may be an appropriate treatment. Methods: Retrospective clinical and radiographic review of 47 patients (22 male, 25 female; mean age 6 y) with modified Gartland type 2 or type 3 supracondylar humerus fracture requiring surgical stabilization and an ipsilateral forearm fracture from a single institution over 78 months. Results: Forty-seven pediatric “floating elbow” cases that had operative management of the supracondylar fracture were identified. A total of 21/47 (45%) had displaced forearm fractures that required closed manipulation. Of these, 17/21 (81%) underwent closed reduction of the displaced forearm fracture(s) and were placed into a noncircumferential cast or splint. No patients lost reduction or required remanipulation of either fracture. No patients developed signs of elevated compartment pressures. All patients went on to radiographic union without secondary procedures. Conclusions: We demonstrate that a supracondylar humerus fracture with an ipsilateral forearm fracture can be safely managed with operative stabilization of the supracondylar humerus fracture alone. Simultaneous closed reduction of the ipsilateral displaced forearm fracture and use of noncircumferential immobilization postoperatively is safe and was not associated with the development of elevated compartment pressures or need for remanipulation. Previous studies that relate a high rate of compartment syndrome with this injury pattern may be misguided, as method of postoperative immobilization may be a more significant factor in the development of elevated compartment pressures than the injury pattern. Level of Evidence: Level IV. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.