Top

Journal of Trauma Management & Outcomes

Published in:

Open Access 01-12-2007 | Research

The floating knee: epidemiology, prognostic indicators & outcome following surgical management

Authors: Ulfin Rethnam, Rajam S Yesupalan, Rajagopalan Nair

Published in: Journal of Trauma Management & Outcomes | Issue 1/2007

Abstract

Background

Floating Knee injuries are complex injuries. The type of fractures, soft tissue and associated injuries make this a challenging problem to manage. We present the outcome of these injuries after surgical management.

Methods

29 patients with floating knee injuries were managed over a 3 year period. This was a prospective study were both fractures of the floating knee injury were surgically fixed using different modalities. The associated injuries were managed appropriately. Assessment of the end result was done by the Karlstrom criteria after bony union.

Results

The mechanism of injury was road traffic accident in 27/29 patients. There were 38 associated injuries. 20/29 patients had intramedullary nailing for both fractures. The complications were knee stiffness, foot drop, delayed union of tibia and superficial infection. The bony union time ranged from 15 – 22.5 weeks for femur fractures and 17 – 28 weeks for the tibia. According to the Karlstrom criteria the end results were Excellent – 15, Good – 11, Acceptable – 1 and Poor – 3.

Conclusion

The associated injuries and the type of fracture (open, intra-articular, comminution) are prognostic indicators in the Floating knee. Appropriate management of the associated injuries, intramedullary nailing of both the fractures and post operative rehabilitation are necessary for good final outcome.

Available only for authorised users

Veith RG, Winquist RA, Hansen ST: Ipsilateral fractures of the femur and tibia. J Bone and Joint Surgery. 1984, 66-A (7): 991-1002.

Fraser RD, Hunter GA, Waddell JP: Ipsilateral fracture of the femur and tibia. J Bone Joint Surg Br. 1978, 60-B (4): 510-5.PubMed

Behr JT, Apel DM, Pinzur MS, Dobozi WR, Behr MJ: Flexible intramedullary nails for ipsilateral femoral and tibial fractures. J Trauma. 1987, 27 (12): 1354-1357.CrossRefPubMed

Gregory P, DiCicco J, Karpik K, DiPasquale T, Herscovici D, Sanders R: Ipsilateral fractures of the femur and tibia: treatment with retrograde femoral nailing and unreamed tibial nailing. J Orthop Trauma. 1996, 10 (5): 309-16. 10.1097/00005131-199607000-00004.CrossRefPubMed

Hayes JT: Multiple fractures in the same extremity: Some problems in their management. Surgical Clinics of North America. 1961, 41: 1379-1388.PubMed

Omer GE, Moll JH, Bacon WL: Combined fractures of the femur and tibia in a single extremity. J Trauma. 1968, 8 (6): 1026-41.CrossRefPubMed

Ostrum RF: Treatment of floating knee injuries through a single percutaneous approach. Clin Orthop Relat Res. 2000, 375: 43-50. 10.1097/00003086-200006000-00006.CrossRefPubMed

Ratcliff AH: Fractures of the shaft of the femur and tibia in the same limb. Pro Roy Soc Med. 1968, 61: 907-908.

Gustilo RB, Anderson JT: Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976, 58 (4): 453-8.PubMed

10.

Blake R, McBryde A: The Floating Knee: Ipsilateral fractures of the tibia and femur. South Med J. 1975, 68 (1): 13-6.PubMed

11.

Karlstrom G, Olerud S: Ipsilateral fracture of the femur and tibia. J Bone Joint Surg Am. 1977, 59 (2): 240-3.PubMed

12.

Adamson GJ, Wiss DA, Lowery GL, Peters CL: Type II floating knee: ipsilateral femoral and tibial fractures with intraarticular extension into the knee joint. J Orthop Trauma. 1992, 6 (3): 333-9. 10.1097/00005131-199209000-00011.CrossRefPubMed

13.

Dwyer AJ, Paul R, Mam MK, Kumar A, Gosselin RA: Floating knee injuries: long-term results of four treatment methods. Int Orthop. 2005, 29 (5): 314-8. 10.1007/s00264-005-0679-x.CrossRefPubMedPubMedCentral

14.

Lundy DW, Johnson KD: "Floating knee" injuries: ipsilateral fractures of the femur and tibia. J Am Acad Orthop Surg. 2001, 9 (4): 238-45.CrossRefPubMed

15.

Theodoratos G, Papanikolaou A, Apergis E, Maris J: Simultaneous ipsilateral diaphyseal fractures of the femur and tibia: treatment and complications. Injury. 2001, 32 (4): 313-5. 10.1016/S0020-1383(00)00189-3.CrossRefPubMed

16.

Oh CW, Oh JK, Min WK, Jeon IH, Kyung HS, Ahn HS, Park BC, Kim PT: Management of ipsilateral femoral and tibial fractures. Int Orthop. 2005, 29 (4): 245-50. 10.1007/s00264-005-0661-7.CrossRefPubMedPubMedCentral

17.

Ríos JA, Ho-Fung V, Ramírez N, Hernández RA: Floating knee injuries treated with single-incision technique versus traditional antegrade femur fixation: a comparative study. Am J Orthop. 2004, 33 (9): 468-72.PubMed

18.

Schiedts D, Mukisi M, Bouger D, Bastaraud H: Ipsilateral fractures of the femoral and tibial diaphyses. Rev Chir Orthop Reparatrice Appar Mot. 1996, 82 (6): 535-40.PubMed

19.

Szalay MJ, Hosking OR, Annear P: Injury of the knee ligament associated with ipsilateral femoral and tibial shaft fractures. Injury. 1990, 21 (6): 398-400. 10.1016/0020-1383(90)90129-I.CrossRefPubMed

20.

Paul GR, Sawka MW, Whitelaw GP: Fractures of the ipsilateral femur and tibia: emphasis on intra-articular and soft tissue injury. J Orthop Trauma. 1990, 4 (3): 309-14. 10.1097/00005131-199003000-00013.CrossRefPubMed

21.

Hung SH, Lu YM, Huang HT, Lin YK, Chang JK, Chen JC, Tien YC, Huang PJ, Chen CH, Liu PC, Chao D: Surgical treatment of type II floating knee: comparisons of the results of type IIA and type IIB floating knee. Knee Surg Sports Traumatol Arthrosc. 2007, 15 (5): 578-86. 10.1007/s00167-006-0252-1.CrossRefPubMed

22.

Yokoyama K, Tsukamoto T, Aoki S, Wakita R, Uchino M, Noumi T, Fukushima N, Itoman M: Evaluation of functional outcome of the floating knee injury using multivariate analysis. Arch Orthop Trauma Surg. 2002, 122 (8): 432-5.PubMed

23.

Arslan H, Kapukaya A, Kesemenli CC, Necmioğlu S, Subaşi M, Coban V: The floating knee in adults: twenty-four cases of ipsilateral fractures of the femur and the tibia. Acta Orthop Traumatol Turc. 2003, 37 (2): 107-12.PubMed

24.

Hee HT, Wong HP, Low YP, Myers L: Predictors of outcome of floating knee injuries in adults: 89 patients followed for 2–12 years. Acta Orthop Scand. 2001, 72 (4): 385-94. 10.1080/000164701753542050.CrossRefPubMed

Title: The floating knee: epidemiology, prognostic indicators & outcome following surgical management
Authors: Ulfin Rethnam
Rajam S Yesupalan
Rajagopalan Nair
Publication date: 01-12-2007
Publisher: BioMed Central
Published in: Journal of Trauma Management & Outcomes / Issue 1/2007
Electronic ISSN: 1752-2897
DOI: https://doi.org/10.1186/1752-2897-1-2

At a glance: The STEP trials

Springer Medicine

The floating knee: epidemiology, prognostic indicators & outcome following surgical management

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2007

Specialisation of spinal services: consequences for cervical trauma management in the district hospital

A geographic information system to study trauma epidemiology in India

Journal of Trauma Management & Outcomes: a new platform for interdisciplinary, outcome-oriented research in trauma

Complex proximal femoral fractures in the elderly managed by reconstruction nailing – complications & outcomes: a retrospective analysis

Sledding injuries: is safety in this winter pastime overlooked? A three-year survey in South-Tyrol

Is mechanism of injury alone in the prehospital setting a predictor of major trauma – a review of the literature