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Eylon S, Schless SH, Lieberman M, Frankl M, Simanovsky N. A rare complication of a rare pediatric injury: Transient drop foot following a floating knee injury. Trauma Case Rep 2023; 48:100927. [PMID: 37731864 PMCID: PMC10507153 DOI: 10.1016/j.tcr.2023.100927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/22/2023] Open
Abstract
Floating Knee is a rare injury caused by high velocity, and has rarely been described in children. The purpose of this report is to present a case of a six-year-old female after a fall down three and a half flights of stairs, suffering from this rare injury and a rare complication, and her rehabilitation. She suffered fractures of the femur and tibia (Floating Knee type), and was operated on the day of the injury with closed reduction and internal fixation (CRIF). Following the operation, painful drop-foot was evident, related to the fractured bone pressure on the sciatic nerve and a very high level of anxiety. The patient was transferred to a rehabilitation hospital, where she received a total of about 350 physical therapy, hydrotherapy, psychology and occupational therapy treatments over a period of one year. Treatment also consisted of an ankle-foot orthosis (AFO) and transcutaneous electrical stimulation, and were assisted with examinations at the motion analysis laboratory using surface electromyography. The combined orthopedic and physical therapy treatment, and cooperation with psychology in the intervention and training for the care team, enabled achievement of all rehabilitation goals. The patient returned to a high functional level and full participation in daily life activities with her peers, without the need for the AFO or further treatment in the community. A re-examination after about six months showed continued functional improvement according to objective indicators. This case raises awareness of rare injuries and complications in pediatric orthopedic patients, that require multidisciplinary rehabilitation treatment and cooperation between the surgical and rehabilitation teams. Closed injury of the sciatic nerve can be followed for a long period without additional invasive studies or formal nerve exploration, and complete recovery can be achieved.
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Affiliation(s)
- Sharon Eylon
- Pediatric Orthopedic Service, ALYN Hospital, Jerusalem, Israel
- The Helmsley Pediatric and Adolescent Rehabilitation Research Center, ALYN Hospital, Jerusalem, Israel
| | - Simon-Henri Schless
- The Helmsley Pediatric and Adolescent Rehabilitation Research Center, ALYN Hospital, Jerusalem, Israel
- Motion Analysis and Biofeedback Laboratory, ALYN Hospital, Jerusalem, Israel
| | | | - Michal Frankl
- Pediatric Orthopedic Service, ALYN Hospital, Jerusalem, Israel
| | - Naum Simanovsky
- Dept. of Orthopedic Surgery, Hadassah Medical Center, Jerusalem, Israel
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Bozgeyik B, Büyükbebeci O, Güner S, Mert A. COMPARATIVE ANALYSIS OF OPEN AND CLOSED FLOATING KNEE INJURIES. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e262810. [PMID: 37547232 PMCID: PMC10399990 DOI: 10.1590/1413-785220233104e262810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/22/2022] [Indexed: 08/08/2023]
Abstract
Objective To compare the functional outcomes between floating knee injuries with open femur and tibia fractures and closed floating knee injuries. Methods Floating knee injuries (followed up and treated in our clinic) were retrospectively analyzed. Patients were divided into two groups: floating knee injuries with open femur and tibia fractures (Group 1) and floating knee injuries with closed femur and tibia fractures (Group 2). Patients were compared according to their demographic characteristics and clinical and functional outcomes. Results Of 52 study patients, 28 had Group 1 injuries and 24, Group 2 injuries. We found a statistically significant difference in length of hospital stay between the two groups (p = 0.01) and a statistically significant difference in Karlström-Olerud functional scores between the groups (p = 0.02). We found osteomyelitis in five (17%) patients in Group 1 and in one (4%) patient in Group 2. Conclusion Patients with floating knee injuries and open fractures showed poorer outcomes than those with closed fractures. Those with open floating knee injuries show complications more often and longer hospital stays. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.
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Affiliation(s)
- Bahri Bozgeyik
- Kadirli State Hospital, Department of Orthopedic Surgery, Osmaniye, Türkiye
| | - Orhan Büyükbebeci
- Gaziantep University Hospital, Department of Orthopedic Surgery, Gaziantep, Türkiye
| | - Savaş Güner
- Gaziantep University Hospital, Department of Orthopedic Surgery, Gaziantep, Türkiye
| | - Ahmet Mert
- Ömer Halis Demir Unıversity Hospital, Department of Orthopedic Surgery, Niğde, Türkiye
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Engorn JR, Vivace BJ, Seligson D, Parkulo T, Arrington DD, Rashid SF, Roberts C, Zamora R. Intramedullary nailing of concurrent ipsilateral fractures of the tibia and femur: primary synchronous nailing versus staged osteosynthesis with temporizing external fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03340-w. [PMID: 35932307 DOI: 10.1007/s00590-022-03340-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The optimal timing to definitive osteosynthesis in the polytraumatized patient remains an unanswered question. Early total care, damage control orthopaedics, and early appropriate care have been described to manage the fractures in these patients, but there is a paucity of literature specific to ipsilateral tibial and femoral fractures. We sought the perioperative outcomes of primary simultaneous intramedullary nailing (IMN) versus temporizing external fixation (EF) of both fractures. METHODS A chart review of all patients who sustained fractures of the ipsilateral femur and tibia that were definitively treated with (IMN) from January 2010 to December 2020 was performed. Patients who underwent initial EF and those that were primarily treated with IMNs were examined. RESULTS IMNs and EF were the initial treatment in 23 and 16 patients, respectively. The mean (range) injury severity score (ISS) was 23.3 (33) in the EF group vs. 18.5 (34) in the IMN group, (p = 0.0686). The EF group had a higher total transfused units of packed red blood cells 7.4 vs. 2.8, the mean initial operative time was 236 vs. 282.6 (min), (p = 0.7399), a longer mean total operative time 601.78 vs. 236 (min), and longer mean length of stay 15.6 vs. 11 (days), (p < 0.5). Rates of complications were not significantly different between groups. CONCLUSION Primary IMN is as safe as provisional EF in the adequately resuscitated patient with ipsilateral femoral and tibial fractures. This implies the fixation of both fractures into a single surgery without increasing perioperative complications, and decreasing total hospital stay in patients with sufficient preoperative resuscitation.
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Affiliation(s)
- Jeffrey R Engorn
- Department of Orthopaedic Surgery, University of Louisville, University of Louisville School of Medicine, 550 South Jackson Street 1st Floor Ambulatory Care Building, Louisville, KY, 40292, USA
| | - Bradley J Vivace
- Department of Orthopaedic Surgery, University of Missouri, University of Missouri School of Medicine, Columbia, USA
| | - David Seligson
- Department of Orthopaedic Surgery, University of Louisville, University of Louisville School of Medicine, 550 South Jackson Street 1st Floor Ambulatory Care Building, Louisville, KY, 40292, USA
| | - Travis Parkulo
- Department of Orthopaedic Surgery, University of Louisville, University of Louisville School of Medicine, 550 South Jackson Street 1st Floor Ambulatory Care Building, Louisville, KY, 40292, USA
| | | | - Salwa F Rashid
- Department of Orthopaedic Surgery, University of Louisville, University of Louisville School of Medicine, 550 South Jackson Street 1st Floor Ambulatory Care Building, Louisville, KY, 40292, USA
| | - Craig Roberts
- Department of Orthopaedic Surgery, University of Louisville, University of Louisville School of Medicine, 550 South Jackson Street 1st Floor Ambulatory Care Building, Louisville, KY, 40292, USA
| | - Rodolfo Zamora
- Department of Orthopaedic Surgery, University of Louisville, University of Louisville School of Medicine, 550 South Jackson Street 1st Floor Ambulatory Care Building, Louisville, KY, 40292, USA.
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Selvam S, Ganesh J. Bilateral floating knee: A rare case report. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2022. [DOI: 10.4103/jotr.jotr_50_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hosny GA, Ahmed ASAA, Tabl EA. Neglected infected floating knee injury: evaluation of closed reduction techniques. Eur J Trauma Emerg Surg 2021; 48:2331-2339. [PMID: 34215902 DOI: 10.1007/s00068-021-01745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Floating knee injury is uncommon yet challenging problem. The situation is more complicated by presence of infection, open comminuted fractures, and late presentation. The aim of this study was to evaluate the closed reduction techniques by circular external fixation in a single stage to treat patients having infected neglected floating knee injuries. METHODS This retrospective study included 19 patients with a mean age of 34.4 years. The average duration from trauma to surgery was 51.1 days. All patients had at least one infected open fracture. According to Fraser's classification, ten injuries were type I, one case was type IIa, four were type IIb, and four were type IIc. Patients were treated by closed reduction techniques using the Ilizarov principles. Orthoplastic procedures were done in four cases in the same surgical setting. RESULTS Closed reduction and union were achieved in all cases with control of infection in 17 cases. The follow-up period averaged 41 months. The mean knee flexion was 97.4°. The complications included 5° extension lag (two cases), malunion (three cases), refracture (two cases), and DVT (four cases). The bone results were excellent (12 cases), good (5 cases), and poor (2 cases). The functional results were excellent (two cases), good (seven cases), acceptable (seven cases), and poor (three cases). CONCLUSIONS Closed reduction techniques using a circular frame provided a valid treatment option for infected neglected floating knee injuries in one stage without bone grafting. However, the high rate of complications and the diminished knee range of motion should be considered.
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Affiliation(s)
- Gamal Ahmed Hosny
- Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Farid Nada Street, Kalyubia, Benha, 13518, Egypt
| | - Abdel-Salam Abdel-Aleem Ahmed
- Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Farid Nada Street, Kalyubia, Benha, 13518, Egypt.
| | - Eslam Abdelshafi Tabl
- Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Farid Nada Street, Kalyubia, Benha, 13518, Egypt
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Piedra-Calle CA, García-Sánchez Y, Teixidor-Serra J, Tomás-Hernández J, Selga-Marsá J, Porcel-Vázquez JA, Molero-García V, Andrés-Peiró JV. Challenges and outcomes in the treatment of floating knees. A case series of ipsilateral femur and tibia fractures around the knee. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:325-331. [PMID: 33884493 DOI: 10.1007/s00590-021-02981-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ipsilateral femur and tibia fractures around the knee (floating knee) are rare injuries that threaten both limb viability and patient life. A correct surgical strategy is essential to reduce complications and sequelae. The aim of this study was to evaluate characteristics and results of treatment in patients with a floating knee treated at a single trauma center. MATERIAL AND METHODS This is a retrospective and non-consecutive case series of 18 floating knees occurred in 17 patients. All patients were operated in a single third-level public and university hospital from December 2010 to December 2018. Data on demographics, injuries, treatment and follow-up were collected. A general health questionnaire (SF-12) and a knee functional questionnaire (KOOS-PS) were used to display results. RESULTS We identified 13 men and 4 women, aged between 16 and 52. Mean follow-up period was 16.49 months. High-energy trauma following a traffic collision was the most frequent mechanism. Mean Injury Severity Score (ISS) was 39.05, and a damage control strategy was used in 15 (83.33%) injuries. Extra-articular fractures (Fraser I) largely predominated, resulting in double intramedullary nailing in 72.22% of cases. Eleven injuries (61.11%) presented with an open fracture. Complications appeared in 6 (33.33%) injuries, being 3 infections. Mean score for the SF-12 was 35.59 for the physical dimension and 50.44 for mental dimension. Mean score for the KOOS-PS was 43.64. CONCLUSION Floating knee injuries usually occur in polytrauma contexts. Visceral involvement and exposed fractures are common, so the most appropriate strategy is usually a staged treatment. Complications and sequelae are frequent.
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Affiliation(s)
| | | | - Jordi Teixidor-Serra
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Selga-Marsá
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juan-Antonio Porcel-Vázquez
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Vicente Molero-García
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Alencar JBDE, Lira RCA, Cavalcante RDAS, Lopes MBG, Sousa CJDDE, Lima DADE. INCIDENCE OF DEEP VEIN THROMBOSIS IN FLOATING KNEE. ACTA ORTOPEDICA BRASILEIRA 2021; 29:17-20. [PMID: 33795963 PMCID: PMC7976868 DOI: 10.1590/1413-785220212901230444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 07/14/2020] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To report the incidence of deep vein thrombosis (DVT) in ipsilateral femur and tibial fractures (floating knee). METHODS This is a retrospective, analytical, observational study conducted with the medical records of thirty patients admitted to a trauma hospital between October 2016 and July 2017 with floating knee. RESULTS Patients aged between 21-30 years were the most affected by the condition (36%). Seventeen patients affected the dominant limb (57%); 19 (63%) patients were classified as Fraser type I, 18 (60%) had open (compound) fractures, 16 (53%) tibial fractures, and 8 (26%) femoral fractures. External fixation of the femur and tibia (25 patients = 83%) was the most common emergency treatment. In total, 17% of patients presented deep venous thrombosis (p = 0.409). CONCLUSION Despite antithrombotic prophylaxis, the incidence of DVT in the affected limb of patients with floating knee was high. We found patients with Fraser I fractures, male, and with fractures in the non-dominant limb to present a higher chance of developing DVT. Level of Evidence III, Comparative retrospective study .
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Karslı B, Tekin SB. The Floating Knee Injuries: Does it Need a New Classification System? Indian J Orthop 2020; 55:499-505. [PMID: 33927831 PMCID: PMC8046864 DOI: 10.1007/s43465-020-00298-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aims to determine the differences between the clinical and radiological results of patients based on Karlstrom-Olerud Scoring System who cannot be included in any classification for floating knee injuries and to seek an answer to the question of whether a new classification is needed. MATERIAL AND METHODS Seventy patients with floating knee injuries treated in our clinic were retrospectively analyzed between 2008 and 2019 in the study. The results of fractures that classifiable and unclassifiable according to the Fraser, Blake and McBryde classifications were statistically compared based on the Karlstrom-Olerud criteria. RESULTS Seventy patients, 64 males and 6 females, participated in the study. The mean age of our patients was 32.3 ± 12.55 (18-68) years. The mean follow-up period of the patients was 30.26 ± 18.19 months (11-60 months). The results of the fractures that could not be classified according to the Blake and McBryde classification were statistically poorer than the results of those that could be classified according to the criteria (p = 0.041).The results of the fractures that could not be classified according to the Fraser classification were statistically poorer than the results of those that could be classified according to the criteria defined by Karlstrom and Olerud (p = 0.010). CONCLUSION We observed that floating knee injuries that we could and could not classify led to different clinical results. In conclusion, we think that there is a need for a new floating knee classification that includes segmental fractures, patellar fractures and open fractures.
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Affiliation(s)
- Burçin Karslı
- grid.411549.c0000000107049315Tıp Fakültesi Ortopedi ve Travmatoloji AD, Gaziantep Üniversitesi, Üniversite Bulvarı, Şehitkamil, 27310 Gaziantep, Turkey
| | - Sezgin Bahadır Tekin
- Department of Orthopaedics and Traumatology, Ersin Arslan Education Research Hospital, Gaziantep, Turkey
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Jain A, Shukla R, Jain R. Long-term study of functional outcomes of floating knee injuries. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_10_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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