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Scholl Schell M, Xavier de Araujo F, Silva MF. Physiotherapy assessment and treatment of patients with tibial external fixator: a systematic scoping review. Disabil Rehabil 2024; 46:1673-1684. [PMID: 37118977 DOI: 10.1080/09638288.2023.2202419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/08/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To map evidence regarding physiotherapy assessment and treatment of patients with tibial external fixator (EF), and to point out literature gaps for further research. METHODS Systematic scoping review conducted in four databases. We included both experimental and non-experimental studies involving patients with tibial EF and outcomes of interest. We recorded study design, population, sample size, sample age, reason for EF use, type of surgery, type of EF used, instruments used for assessing function, pain, quality of life, satisfaction, psychosocial aspects, and physiotherapy treatment descriptions from included studies. We categorised data accordingly to outcomes assessed and physiotherapy treatments description. RESULTS Eighty-six studies were included involving 3070 patients. Causes of fixator use were traumatic conditions, acquired and congenital deformities, and non-traumatic conditions, like compartmental osteoarthritis. Function was assessed in about three-quarters of included studies, though other outcomes were not presented in most studies. Only one study described satisfactorily the physiotherapy treatment. Almost half of the studies did not provide any description of the rehabilitation process. CONCLUSIONS There is little evidence about the assessment of function, pain, quality of life, satisfaction, psychosocial aspects, and other outcomes in tibial EF patients. Physiotherapy treatment in these patients is poorly reported.Protocol registration: Open Science Framework: doi:10.17605/OSF.IO/UT2DA.
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Affiliation(s)
- Mauricio Scholl Schell
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | - Marcelo Faria Silva
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Yadav S, Rawal G. Advances in Understanding and Managing Floating Knee Injuries: A Comprehensive Review. Cureus 2024; 16:e57122. [PMID: 38681444 PMCID: PMC11055540 DOI: 10.7759/cureus.57122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Fractures of the ipsilateral tibia and femur, frequently combined with soft tissue damage and dislocations, describe floating knee injuries, a complicated orthopedic condition. Epidemiological data suggest that floating knee injuries account for a small but significant proportion of traumatic orthopedic injuries, with a higher incidence observed in younger males engaged in high-risk activities. Anatomically, floating knee injuries involve fractures of the femur and tibia, ligamentous disruptions, and soft tissue damage, contributing to the complexity and severity of these injuries. An extensive analysis of floating knee injuries is given in this paper, including information about epidemiology, anatomy, pathophysiology, categorization, management approaches, complications, prognosis, and current and upcoming developments.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| | - Gautam Rawal
- Respiratory Medical Critical Care, Max Super Speciality Hospital, New Delhi, IND
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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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Kenmegne GR, Zou C, Lin Y, Yin Y, Huang S, Fang Y. The current issues and challenges in the management of floating knee injury: a retrospective study. Front Surg 2023; 10:1164032. [PMID: 37206352 PMCID: PMC10189139 DOI: 10.3389/fsurg.2023.1164032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Purpose The management of floating knee injuries is still controversial and challenging for trauma specialists. This study aims to evaluate the incidence of the floating knee in lower limb trauma, analyzing the challenges in its management, and factors affecting clinical outcomes. Methods In this mono-center retrospective study, 36 consecutive patients were included. All individuals were diagnosed with an ipsilateral fracture of the femur and tibia, managed surgically according to their fracture pattern (Fraser classification), and the severity of the injury. The timing for each operation was determined based on the general condition of the patient and the local physiological condition of soft tissues. The patients' clinical outcomes were finally evaluated based on their Karlstrom and Olerud scores and were categorized as excellent, good, acceptable, fair, or poor. Results In this study, the mean follow-up period was 51.39 ± 16.02 months (11-130 months). Incidence of the floating knee was 2.32% in all lower limb traumas. From this number, 16 patients suffered from floating knee injury in the left lower extremity, and 18 in the right lower limb, while in 2 patients the condition was bilateral. The most common injury mechanism was road traffic accidents, accounting for 28 (77.78%) cases. The outcome was as follows; Excellent to good results in 22 (61.11%) cases, acceptable results in 2 (5.56%) cases, and fair to poor results in 12 (33.33%) cases according to the Karlström-Olerud scoring system. The most frequent early complications were wound infection and deep venous thrombosis in 5 (13.88%) of the cases. The most common late complication was common peroneal nerve palsy recorded in 2 (5.56%) cases. Conclusion The presence of important concomitant injuries to the floating knee together with poor soft tissue conditions constituted important factors influencing possible management options and may have led to poorer clinical outcomes.
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Green JS, Seddio AE, Roybal D, Moran J, Katz LD, Medvecky MJ. Spontaneous Healing of a Posteriorly Displaced Lateral Meniscus Bucket-Handle Tear in a Multiligament Knee Injury: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00041. [PMID: 36821095 DOI: 10.2106/jbjs.cc.22.00503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/14/2022] [Indexed: 02/24/2023]
Abstract
CASE Bucket-handle meniscus tears (BHMTs) typically involve the medial meniscus and often occur with concomitant rupture of the anterior cruciate ligament. We report an unusual case of a polytrauma patient who sustained a bicruciate multiligament knee injury (MLKI) with a posteriorly displaced lateral BHMT that spontaneously healed after reduction of the fragment. At the 2-year follow-up, the lateral meniscus was clinically stable without pain. CONCLUSION A lateral BHMT with a posteriorly displaced fragment produced an atypical magnetic resonance imaging presentation in a bicruciate MLKI. Meniscal repair was aborted because of extravasation and concerns of compartment syndrome, but spontaneous healing occurred after fragment reduction.
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Affiliation(s)
- Joshua S Green
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - Anthony E Seddio
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | | | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Lee D Katz
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.,Department of Radiology, Musculoskeletal Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Michael J Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
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Ethiraj P, Shringeri AS, Prasad P A, Shanthappa AH, Nagarajan V. Early Total Care Versus Damage Control Orthopedics in Floating Knee Injury: Analysis of Radiological and Functional Outcomes. Cureus 2022; 14:e25615. [PMID: 35784973 PMCID: PMC9249040 DOI: 10.7759/cureus.25615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Floating knee injury (FKI) occurs as a result of a high-velocity impact. We assessed the radiological and functional outcomes of FKIs treated by various fixation methods, by damage control orthopedics (DCO) or early total care (ETC). Materials and methods We investigated 46 patients with FKI who were operated on between January 2013 and January 2018 at the RL Jalappa Hospital and Research Center, Kolar, India. Functional assessments were evaluated using Karlström and Olerud’s criteria (KOC). Based on their treatments, the patients were divided into the damage control orthopedics group (n = 21) and the ETC group (n = 25). Statistical analyses were used to obtain and compare summary data. Results The data of 46 patients were collected. Fractures were classified using the modified Fraser’s classification. Five patients were not included in the final analysis because of death due to complications in the immediate postoperative period. In patients managed by DCO, after radiological union, the functional outcome was excellent in three cases, good in eight, fair in seven, and poor in two. The average time required for radiological union of the femur was 10.75 ± 1.482 months (P = 0.001); for tibia union, it was 10.25 ± 1.682 months (P = 0.011). The average range of knee flexion was 85°± 16.059° (P = 0.001), which was statistically significant. In patients managed by ETC, there were six cases with an excellent functional outcome, 13 with a good outcome, and two with a fair outcome. The average time required for radiological union of the femur was 9.29 ± 1.765 months (P = 0.006); for the tibia, it was 9.05 ± 1.161 months (P = 0.012). The average range of knee flexion was 100° ± 10.954° (P = 0.001), which was statistically significant. Fat embolism was noted in eight cases; four of these patients died due to multiorgan dysfunction. This was the major life-threatening complication in the early definitive fixation group. In the DCO group, only three cases had fat embolism, with one death due to multiorgan dysfunction. Early postoperative infection was a concern in the ETC group, evident in six cases. Conclusion The classification system for FKI needs further research, which must include multiple parameters. Fracture classification and patient selection are crucial considerations in deciding the best treatment for a particular fracture.
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Alencar Neto JB, Osório Neto EB, Souza CJDD, da Rocha PHM, Cavalcante MLC, Lopes MBG. Evaluation of the Interobserver Agreement of the Fraser and Blake & McBryde Classifications for Floating Knee. Rev Bras Ortop 2021; 56:459-462. [PMID: 34483389 PMCID: PMC8405262 DOI: 10.1055/s-0040-1713388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/17/2020] [Indexed: 10/31/2022] Open
Abstract
Objective To evaluate the interobserver agreement of two classifications for floating knee: Fraser and Blake & McBryde. Method Thirty-two observers, subdivided according to the degree of titration (26 resident physicians and 6 orthopedic physicians specialized in orthopedic trauma), classified 15 fractures of the ipsilateral femur and tibia. Interobserver agreement was evaluated by using the Kappa coefficient . Result When evaluating the agreement between the 9 R1, a Kappa index of 0.58 was obtained for the Fraser classification and of 0.46 for the Blake & McBryde classification. Among the 7 R2, a rate of 0.59 was obtained for the Fraser rating and 0.51 for the Blake & McBryde rating. Among the 10 R3, the agreement index was higher for both classifications: 0.72 for the Fraser and 0.71 for the Blake & McBryde classification. Considering the 3 groups (R1, R2, R3) as one large group, the general Kappa index was calculated, which resulted in 0.63 for the Fraser classification and 0.56 for the Blake & McBryde classification. In the group of trauma and orthopedic knee specialists, in turn, an agreement of 0.597 was obtained for the Blake and McBryde classification and of 0.843 for the Fraser classification. Conclusion Comparatively, the two classifications presented a weak to moderate degree of agreement. Fraser classification had better agreement in both groups. The agreement was higher when evaluating orthopedic trauma physicians.
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Affiliation(s)
| | | | | | | | - Maria Luzete Costa Cavalcante
- Disciplina de Ortopedia e Traumatologia, Departamento de Cirurgia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
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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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Abstract
The "floating knee" is defined as fractures of the ipsilateral femur and tibia, which consists of a spectrum of injury, and may be in isolation or part of multiple system trauma for a given patient. A floating knee may compromise limb viability due to severe soft-tissue and vascular injury. Expeditious fracture reduction and patient resuscitation are crucial, while type and timing of provisional and definitive management is guided by the extent of injury to the involved extremity and associated systemic injuries. Numerous surgical techniques are available to treat the floating knee, including external fixation and internal fixation with plates or intramedullary nails. Fracture complexity and severity of soft-tissue injury present challenges, with articular injuries potentially more debilitating in the long term. Complications such as infection, deep vein thrombosis, knee stiffness, nonunion, malunion, and posttraumatic arthrosis after these injuries should be considered.
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Nwosu C, Salawu O, Mejabi J, Fadimu A. Management of floating knees in adults: Experience from tertiary hospital. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_25_18] [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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Rollo G, Falzarano G, Ronga M, Bisaccia M, Grubor P, Erasmo R, Rocca G, Tomé-Bermejo F, Gómez-Garrido D, Pichierri P, Rinonapoli G, Meccariello L. Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years. Injury 2019; 50 Suppl 4:S30-S38. [PMID: 30910244 DOI: 10.1016/j.injury.2019.03.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Floating knee is a flail knee joint resulting from fractures of the shafts or adjacent metaphyses of the femur and the ipsilateral tibia. It is usually associated with several complications and mortality. This study was designed to present our experience with the treatment of this injury. MATERIAL AND METHOD This study was performed between January 2004 and December 2014. 224 cases of floating knee injuries gathered from the 34,480 lower extremities trauma files were studied, and the target information recorded. The injuries most frequently occurred in subjects between 16 and 35 years of age (60.71%), and in male subjects (85.71%). The most frequent mechanism of injury was traffic accident (92.85%). External fixation was the common type of treatment (82.14%) in emergency or as a definitive treatment. The treatment was performed within 24 h of the trauma. We performed a 36-month follow up with clinical examination, radiographs, assessing the complications, and using the Modified Cincinnati Rating System Questionnaire (MCRSQ) and the Karlström/Olerud Score (KOS) to evaluate the progression of the outcomes. RESULTS Early complications included 8 cases of compartment syndrome, 60 open fractures and 24 partially amputated limbs. A total amputation was performed in 3 patients. The most common late complication was heterotopic calcifications of the knee (n = 68, 30.6%). Good scores for MCRSQ and KOS were obtained only after patients were sent to a reference center for knee surgery. CONCLUSIONS Our experience revealed that the complication rate associated with floatingknee injuries remains high, regardless of the performed treatment. Surgeons should focus on reducing complications while treating these severe injuries.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Gabriele Falzarano
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Mario Ronga
- Department of Medicine and Health Sciences 'Vincenzo Tiberio' University of Molise, Campobasso, Italy
| | - Michele Bisaccia
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Predrag Grubor
- Clinic of Traumatology, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Rocco Erasmo
- Department of Orthopedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Guido Rocca
- Department of Orthopedics and Traumatology, Trauma Center "Pietro Cosma", Camposampiero, PD, Italy
| | - Felix Tomé-Bermejo
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - David Gómez-Garrido
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - Paolo Pichierri
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giuseppe Rinonapoli
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
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Yadav V, Suri HS, Vijayvargiya M, Agashe V, Shetty V. "Floating knee," an Uncommon Injury: Analysis of 12 Cases. Rev Bras Ortop 2019; 54:53-59. [PMID: 31363243 PMCID: PMC6424807 DOI: 10.1016/j.rboe.2017.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/05/2017] [Indexed: 11/17/2022] Open
Abstract
Objective Floating knee injuries are complex injuries and are usually caused by high-velocity trauma. These injuries are often associated with life treating injuries, which should take precedent over extremity injuries. The authors reviewed the outcomes of floating knee injuries managed in this institute from 2003 to 2015. Method A retrospective study was conducted of all patients with floating knee injuries from2003 to 2015. Twelve patients were included in the study. Data related to fracture type, associated injuries, treatment modalities, and complications were noted. Functional assessment was performed using the modified Karlstrom and Olerud criteria after complete bony union. Result The mechanism of injury was motor vehicle accident in all patients. The mean follow up was four years. The mean age of patients was 34.75 year. The mean union time was 6.5 months in femurs and 6.7 month in tibias. The complications were knee stiffness, delayed union, and infection. According to modified Karlstrom criteria, there were three - excellent, five - good, three - fair, and one poor result. Conclusion Floating knee injuries are severe injuries and are usually associated with multi-organ injuries. Early detection and appropriate management of associated injuries, early fixation of fractures, and postoperative rehabilitation are needed for good outcome. Complications are frequent, in the form of delayed union, knee stiffness, and infection.
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Affiliation(s)
- Vishal Yadav
- Departmento de Ortopedia, P.D. Hinduja National Hospital, Mumbai, Maharashtra, India
| | - Harpreet Singh Suri
- Departmento de Ortopedia, P.D. Hinduja National Hospital, Mumbai, Maharashtra, India
| | - Mayank Vijayvargiya
- Departmento de Ortopedia, P.D. Hinduja National Hospital, Mumbai, Maharashtra, India
| | - Vikas Agashe
- Departmento de Ortopedia, P.D. Hinduja National Hospital, Mumbai, Maharashtra, India
| | - Vivek Shetty
- Departmento de Ortopedia, P.D. Hinduja National Hospital, Mumbai, Maharashtra, India
- Address for correspondence Vivek Shetty Department of Orthopedics, P.D. Hinduja National HospitalMumbaiIndia
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Functional outcomes and quality of life in adult ipsilateral femur and tibia fractures. J Orthop Translat 2019; 16:53-61. [PMID: 30723681 PMCID: PMC6350037 DOI: 10.1016/j.jot.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/20/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of our study is to evaluate the functional outcomes and quality of life in adult ipsilateral femur and tibia fractures. Methods 26 patients (21 male, 5 female; mean age 30 years, range: 18 to 66) treated for adult ipsilateral femur and tibia fractures were evaluated retrospectively. For femur fractures, intramedullary nails were used in 15 patients (12 antegrade, 3 retrograde), plate in 11 patients (10 locked-plate, and 1 blade-plate with a 95 degree angle). For tibia fractures, locked-plate were used in 13 patients, intramedullary nails in 9 patients, external fixator in 3 patients and multiple screws in 1 patient. According to Blake and McBryde classification, 17 fractures were type I, 9 fractures were type II (7 type 2A and 2 type 2B). The functional outcomes were evaluated by Karlström and Olerud criteria, and quality of life was evaluated by Short Form-36. The mean follow-up duration was 4.4 years (range: 1.1 to 7.3 years). Results The functional outcomes were excellent in 6 patients, good in 8 patients, acceptable in 6 patients and poor in 6 patients. The mean values of quality of life scales were; physical function: 64.8, physical role limitation: 60.5, pain: 68.2, general health: 63.3, vitality: 58.4, social function: 68.2, emotional role limitation: 62.7, and mental health: 65.8. Conclusion Adult ipsilateral femur and tibia fractures are severe injuries and adversely affect the quality of life and functional outcomes. The quality of life scales should be used along with functional outcome scores in evaluating these injuries. The translational potential of this article Adult ipsilateral femur and tibia fractures cause severe morbidity. Functional outcomes and quality of life scales should be used together to evaluate these fractures. Karlström and Olerud criteria for functional outcomes and Short Form-36 scales for quality of life are suitable methods to evalute these fractures.
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Rollo G, Falzarano G, Ronga M, Bisaccia M, Grubor P, Erasmo R, Rocca G, Tomé-Bermejo F, Gómez-Garrido D, Pichierri P, Rinonapoli G, Meccariello L. WITHDRAWN: Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years. Injury 2019; 50:453-461. [PMID: 30563714 DOI: 10.1016/j.injury.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in Injury, 50(2) (2019) 453–461, https://doi.org/https://doi.org/10.1016/j.injury.2018.12.009. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Gabriele Falzarano
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Mario Ronga
- Department of Medicine and Health Sciences 'Vincenzo Tiberio' University of Molise, Campobasso, Italy
| | - Michele Bisaccia
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Predrag Grubor
- Clinic of Traumatology, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Rocco Erasmo
- Department of Orthopedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Guido Rocca
- Department of Orthopedics and Traumatology, Trauma Center "Pietro Cosma", Camposampiero, PD, Italy
| | - Felix Tomé-Bermejo
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - David Gómez-Garrido
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - Paolo Pichierri
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giuseppe Rinonapoli
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
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Kulkarni MS, Aroor MN, Vijayan S, Shetty S, Tripathy SK, Rao SK. Variables affecting functional outcome in floating knee injuries. Injury 2018; 49:1594-1601. [PMID: 29885963 DOI: 10.1016/j.injury.2018.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/19/2018] [Accepted: 05/22/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The surgical outcome of floating knee injuries is difficult to predict. The high-velocity nature of the injury, complex fracture pattern and associated soft tissue/visceral injuries may have some impact on the functional outcome. The present study evaluates the variables affecting the clinical and radiological outcomes of floating knee injuries. MATERIALS AND METHODS The clinical, radiological and functional outcome (Karlstrom and Olegrud criteria) of 89 patients with 90 floating knee injuries were evaluated at the end of one year who were managed in our level 1 trauma center between January 2013 and December 2016. The details of the injury, fracture pattern, management and complications were collected retrospectively from their records. RESULTS There were 81 (91.1%) males and 8 (8.9%) females with mean age of 34.34 ± 12.28 years. The mean time for tibia and femur union was 9.52 (±6.6) and 10.5 (±7.37) months. There was significant delay (p < 0.005) in time taken for union in segmental femur fractures (14.3 ± 9.6 months) compared to nonsegmental femur fractures (8.68 ± 5.18 months). Such significant difference in time taken for union was not seen in tibial segmental (10.6 ± 4.62 months) and nonsegmental fractures (9.05 ± 7.27 months). As per the Karlstrom and Olegrud criteria, there were 22 (24.4%) excellent, 26 (28.9%) good, 24 (26.7%) fair and 11 (12.2%) poor outcome. There were 15 patients with malunited tibia, 6 with malunited femur, 10 with limb length discrepancy and 39 with knee stiffness. 28 (33.3%) patients underwent major additional procedures such as bone grafting, re-fixation or bone transport or tendon transfer. It was observed that open tibia fracture, segmental fracture, intra-articular fracture, additional surgical procedures, initial external-fixator (ex-fix) application were significantly associated with development of knee stiffness, limb shortening, malalignment and unsatisfactory (Karlstrom and Olegrud fair to poor) functional outcome. CONCLUSION Open tibial fractures, segmental fractures, intraarticular involvement, additional surgical procedures and initial external fixator application are the poor prognostic indicators of floating knee injuries.
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Affiliation(s)
- Mahesh Suresh Kulkarni
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, 576104, India
| | - Monappa Naik Aroor
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, 576104, India.
| | - Sandeep Vijayan
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, 576104, India
| | - Saurabh Shetty
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, 576104, India
| | - Sujit Kumar Tripathy
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, 576104, India
| | - Sharath K Rao
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, 576104, India
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Carta S, Riva A, Fortina M, Colasanti GB, Meccariello L. The Challenges of the Femoral Bone Loss in the Management of the Floating Knee IIB According Fraser: A Case Report. J Orthop Case Rep 2018; 8:3-7. [PMID: 29854682 PMCID: PMC5974666 DOI: 10.13107/jocr.2250-0685.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction This case report describes the management and the possible therapeutic solutions for the treatment of femoral bone loss associated with an open fracture IIIB Gustilo Andersonin a polytrauma that includes floating knee (GF) Fraser IIB from damage control orthopedics to final treatment. Case Report The patient was treated with an external fixator femorotibial bridge after extensive cleaning and debridement of open fractures. After 17-day post-trauma, we substitute the fixator with a less invasive stabilization system plate and screws with contralateral allograft bone strut.3months after the first surgery, the patient underwent surgery for the intramedullary nailing of the tibia. The follow-up was clinical using the knee injury and osteoarthritis outcome score (KOOS), short form 12 health survey (SF-12) for quality of life, and radiological at 1-3-6-12-18-24-36 months. The patient walked with partial load up until the 6months after injury and then began a progression to a total load. At 24-months post surgery, the patient had both the KOOS and SF-12 at 100 points. Conclusion Not all Fraser IIB are equal, the timing of treatment should be discussed case by case. The surgical sequence should be respected: First, the fixation of the femur, and then, the stabilization of the tibia, taking into account the condition of the skin, eventual exposure or the eventual level of sub-amputation of the limb. The clinical and radiographic results show how efficient damage can lay the foundations for an excellent definitive treatment.
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Affiliation(s)
- Serafino Carta
- Department of Orthopedics and Traumatology, University of Siena, University Hospital "Santa Maria Alle Scotte," Siena, Italy
| | - Alberto Riva
- Department of Orthopedics and Traumatology, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Mattia Fortina
- Department of Orthopedics and Traumatology, University of Siena, University Hospital "Santa Maria Alle Scotte," Siena, Italy
| | - Giovanni Battista Colasanti
- Department of Orthopedics and Traumatology, University of Siena, University Hospital "Santa Maria Alle Scotte," Siena, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
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Zhou Y, Guo H, Cai Z, Zhang Y. Complex pelvic ring injuries associated with floating knee in a poly-trauma patient: A case report. Medicine (Baltimore) 2017; 96:e8783. [PMID: 29310353 PMCID: PMC5728754 DOI: 10.1097/md.0000000000008783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care. The purpose of this study is to prove the feasibility and benefits of damage control orthopedics (DCO). PATIENT CONCERN Our case involved a 45-year-old lady who was hit by a dilapidated building. The patient was anxious, pale and hemodynamically stable at the initial examination. The pelvis was unstable and there were obvious deformities in the left lower extremities. Significant degloved injuries in the left leg were noted. Her radiographs and physical examination verified the above signs. DIAGNOSES Unstable pelvic fractures, multiple fractures of bilateral lower limbs with floating knee injury, multiple pelvic and rib fractures and multiple degloving injuries and soft tissue contusion formed the characteristics of the multiple-injury. INTERVENTIONS The algorithm of DCO was determined as the treatment. Early simplified procedures such as wound debridement, pelvis fixation, closed reduction and EF of the right shoulder joint, and chest wall fixation were conducted as soon as possible. After a period of time, internal fixations were applied to the fracture sites. The subsequent functional exercise was also conducted in accordance with this algorithm. OUTCOMES This patient got recovery after the treatments which were guided by the criterion of DCO. The restoration of limb functional and the quality of life greatly improved. LESSONS The DCO plays a decisive role in the first aid and follow-up treatment of this patient. The guidelines of management of complex pelvic ring injuries and floating knee should be established by authorities.
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Affiliation(s)
| | - Honggang Guo
- Department of Orthopedic Surgery, General Hospital of Tianjin Medical University, Tianjin, China
| | | | - Yuan Zhang
- Department of Orthopedic Surgery, General Hospital of Tianjin Medical University, Tianjin, China
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18
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Kaushal M, Chouhan DK, Sharma G, Kanojia RK. Complex knee injury scenario in tertiary level care in North India: An epidemiological study. J Clin Orthop Trauma 2017; 8:S6-S8. [PMID: 29339840 PMCID: PMC5761701 DOI: 10.1016/j.jcot.2016.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/05/2016] [Accepted: 12/15/2016] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Floating knee injury has been considered as one of the severe orthopedic injury, and is often associated with major systemic trauma involving other organs. OBJECTIVE To identify the incidence of floating knee injury, severity of injury and associated orthopaedic and non-orthopaedic injury. METHODS Epidemiologic study conducted from 1 Jan 2014 to 31 Dec 2014. RESULTS A total of 136 cases with floating knee injury were registered. Modified Fraser classification showed 58 patients had type 1, 74 had type 2 and 4 had type 3 floating knees. 119(87.5%) patients had open fractures and Gustilo-Anderson type IIIA(29.4%) being the commonest. No Mortality was found. 16 (11.76%) of floating knees had to undergo amputation of afflicted limb. CONCLUSION Statics of such data would be helpful in planning and preparing ourselves as healthcare professionals to prevent high mortality and morbidity/disability in floating knee injury. STUDY DESIGN Retrospective Epidemiological. LEVEL OF EVIDENCE Level 4 (Case Study).
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19
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Andrade-Silva FB, Carvalho A, Mansano C, Giese A, de Camargo Leonhardt M, Barbosa D, Kojima KE, Silva JS. Functional results and isokinetic muscle strength in patients with Fraser type I floating knee treated with internal fixation. Injury 2017; 48 Suppl 4:S2-S5. [PMID: 29145963 DOI: 10.1016/s0020-1383(17)30767-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION According to Fraser's description, ipsilateral femoral and tibial diaphyseal fractures are characterised as type I floating knee and have a better prognosis than fractures with joint involvement (type II). There are few reports of functional and muscle strength in these patients. The objective of this study was to evaluate the functional and isokinetic muscle strength of patients with type I floating knee undergoing femoral and tibial internal fixation. METHODS Patients with type I floating knee undergoing concomitant femoral and tibial internal fixation were invited for clinical evaluation. The parameters evaluated included the following: Karlstrom and Olerud score; Lysholm score; isokinetic thigh and hip muscle evaluation; knee range of motion; pain level; investigation of associated knee injuries by clinical evaluation and MRI; and types of complications. RESULTS Twenty-one patients were included in the study; 11 of these were clinically evaluated, with a mean follow-up of 23.9 months. Six patients had an acceptable result according to the Karlstrom criteria, whereas eight patients had a poor result based on the Lysholm scale. The peak torque deficit was 61% for knee extensors, 37% for flexors and -9% for hip abductors. The mean pain level was 5.9. Three patients had a partial anterior cruciate ligament (ACL) injury; one patient had a posterior cruciate ligament (PCL) injury; and three patients had a meniscal injury. There were four cases of tibial or femoral nonunion at one year and two cases of chronic osteomyelitis. CONCLUSION Patients with type I floating knee had unsatisfactory functional results, significant knee extensor and flexor muscle strength deficits and a significant rate of complications at the two-year follow-up.
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Affiliation(s)
| | - Adriana Carvalho
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
| | - Caio Mansano
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
| | - Aline Giese
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
| | | | - Dennis Barbosa
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
| | - Kodi Edson Kojima
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
| | - Jorge Santos Silva
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
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Bertrand ML, Andrés-Cano P. Management of the Floating Knee in Polytrauma Patients. Open Orthop J 2015; 9:347-55. [PMID: 26312119 PMCID: PMC4541470 DOI: 10.2174/1874325001509010347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/26/2015] [Accepted: 05/18/2015] [Indexed: 12/24/2022] Open
Abstract
Ipsilateral fracture of the femur and tibia, or floating knee, is a rare injury that is found almost exclusively in polytrauma or high-energy trauma patients. It presents a combination of diaphyseal, metaphyseal and intra-articular fractures of the femur and tibia, with a high incidence of neurovascular, ligamentous and soft-tissue injuries. The functional outcome and, in some cases, the life, of such polytrauma patients depends largely on a correct therapeutic approach being taken. In general, the treatment decided upon will depend on the individual characteristics present, regarding aspects such as the patient’s general condition, the fracture line and the state of the soft tissues. The treatment provided may be the same as when single fractures are presented, but it is often necessary to consider whether certain techniques or surgical approaches may interfere with other lines of treatment. It is essential at all times to take into consideration the associated injuries and complications before deciding upon a treatment strategy. Ligamentous injuries play an important role in these injuries, much more so than when fractures occur singly. Therefore, these injuries require management by an experienced multidisciplinary team.
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Affiliation(s)
- M L Bertrand
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol. University of Malaga, Spain
| | - P Andrés-Cano
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol. University of Malaga, Spain
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21
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Feron JM, Bonnevialle P, Pietu G, Jacquot1 F. Traumatic Floating Knee: A Review of a Multi-Centric Series of 172 Cases in Adult. Open Orthop J 2015; Suppl 1 M11:356-60. [PMID: 26312122 PMCID: PMC4541414 DOI: 10.2174/1874325001509010356] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/26/2015] [Accepted: 05/18/2015] [Indexed: 11/22/2022] Open
Abstract
The traumatic floating knee in adults (FK) is a combined injury of the lower limb defined by ipsilateral fractures of the tibia and femur. The first publications emphasized the severity of injuries, the bad results after conservative treatment, the most severe functional outcome in case of articular fracture and the frequency of associated cruciate ligament injuries. The surgical management of FK has been highly modified according the improvement of the fracture fixation devices and the operative techniques. This retrospective multicentric observational study included 172 adults with a FK injury admitted in emergency in 5 different level I or II trauma centers. All the patients data were collected on an anonymized database. Results were evaluated by the overall clinical Karlström's score at latest follow-up. Fracture union was assessed on X-rays when at least 3 out of 4 cortices were in continuity in two different radiological planes. A statistical analysis was performed by a logistic regression method. Despite some limitations, this study confirms the general and local severity of this high-energy trauma, mainly occurring in young people around the third decade. A special effort should lead to a better initial diagnosis of associated ligamentous injury: a tear of PCL can be suspected on a lateral-ray view and a testing of the knee should be systematically performed after fixation of the fracture under anesthesia. Secondary MRI assessment is sometimes difficult to interpret because of hardware artifacts. The timing of fracture fixation is discussed on a case by case basis. However, a first femoral fixation is recommended except in cases of tibia fracture with major soft tissue lesion or leg ischemia requiring the tibia fixation first. Also a tibia stabilized facilitates the reduction and fixation of a complex distal femur fracture. The dual nailing remains so far for us the best treatment in Fraser I FK. Further prospective studies are needed to validate treatment algorithms, best fixation techniques in order to decrease the rate of complication and improve the functional outcome of floating knee injuries.
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Affiliation(s)
- J-M Feron
- Orthopaedic and Trauma Department, HUEP Saint Antoine, UPMC-Sorbonne Universités, Paris, France
| | - P Bonnevialle
- Orthopaedic and Trauma Department, CHU Toulouse. Université Paul Sabatier, Toulouse, France
| | - G Pietu
- Orthopaedic and Trauma Department, CHU Nantes, Université de Nantes, France
| | - F Jacquot1
- Orthopaedic and Trauma Department, HUEP Saint Antoine, UPMC-Sorbonne Universités, Paris, France
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22
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Dahmani O, Elrhazi A, Elidrissi M, Shimi M, Elibrahimi A, Elmrini A. The intramedullary nailing using a single knee incision for treatment of extraarticular floating knee (nine cases). J Emerg Trauma Shock 2014; 7:322-6. [PMID: 25400397 PMCID: PMC4231272 DOI: 10.4103/0974-2700.142774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/06/2013] [Indexed: 11/05/2022] Open
Abstract
Context: Floating knee injuries are uncommon and complex injuries. Management of this injury has been variously described in the literature. Aims: We present the outcome of the intramedullary nailing using a single knee incision for treatment of extraarticular floating knee. Materials and Methods: We report a retrospective series of nine patients with extraarticular floating knee. Results: There were seven men and two women with an average age of 35 years. At least one of the fractures was open in three cases. The average Injury Severity Score was 17. According to Fraser's classification, 100% of the cases are type I. All our patients were treated by the intramedullary nailing using a single knee incision. The mean operating time was 146 min. The mean follow-up is 19 months. According to the Karlström criteria, the end results were excellent in two cases, good in four, acceptable in two, and poor in one. Bone union was achieved in eight cases with an average period of 93 days. Conclusions: The intramedullary nailing using a single knee incision has shown in this series better results.
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Affiliation(s)
- Omar Dahmani
- Department of Orthopaedics (B4), University Hospital Hassan II, Fez, Morocco
| | - Amine Elrhazi
- Department of Orthopaedics (B4), University Hospital Hassan II, Fez, Morocco
| | - Mohamed Elidrissi
- Department of Orthopaedics (B4), University Hospital Hassan II, Fez, Morocco
| | - Mohamed Shimi
- Department of Orthopaedics (B4), University Hospital Hassan II, Fez, Morocco
| | | | - Abdelmajid Elmrini
- Department of Orthopaedics (B4), University Hospital Hassan II, Fez, Morocco
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Chen W, Tang DZ, Guo ZM, Shi B, Lin B, Ding ZQ, Lian KJ. Use a simple lower limb outrigger frame in intramedullary nailing fixation of a floating knee. Orthop Traumatol Surg Res 2014; 100:561-4. [PMID: 25082776 DOI: 10.1016/j.otsr.2014.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 05/14/2014] [Accepted: 05/26/2014] [Indexed: 02/02/2023]
Abstract
Closed intramedullary nailing is a classical therapeutic approach for floating knee injuries. An appropriate positioning is critical for a successful surgery. However, there is a lack of an ideal auxiliary device to facilitate the implantation of intramedullary nail. The authors developed a simple lower limb outrigger frame (SLLOF), which is made of nylon, to facilitate the nail implementation process. The SLLOF could be radiolucent and autoclavable. A total of 31 patients with floating knee injury underwent the closed intramedullary nailing assisted by SLLOF. The average operative duration was 91.0 min, and all tibial and femur fractures reached bony union. The SLLOF could assist well insertion of intramedullary nail for the treatment of floating knee injuries, with the advantages of simple operation, less manpower, easy imaging access but less radiation exposure, and more cost-effectiveness.
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Affiliation(s)
- W Chen
- Department of Orthopaedic Surgery, the Affiliated Dongnan Hospital of Xiamen University, 269 Huazhong Road, 363000 Zhangzhou, Fujian, PR China; Orthopaedic Trauma Center of the 175th Hospital of PLA, 363000 Zhangzhou, Fujian, PR China
| | - D-Z Tang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 200032 Shanghai, PR China
| | - Z-M Guo
- Department of Orthopaedic Surgery, the Affiliated Dongnan Hospital of Xiamen University, 269 Huazhong Road, 363000 Zhangzhou, Fujian, PR China; Orthopaedic Trauma Center of the 175th Hospital of PLA, 363000 Zhangzhou, Fujian, PR China.
| | - B Shi
- Zhengzhou University School of Medicine, 450001 Zhengzhou, Henan, PR China
| | - B Lin
- Department of Orthopaedic Surgery, the Affiliated Dongnan Hospital of Xiamen University, 269 Huazhong Road, 363000 Zhangzhou, Fujian, PR China; Orthopaedic Trauma Center of the 175th Hospital of PLA, 363000 Zhangzhou, Fujian, PR China
| | - Z-Q Ding
- Department of Orthopaedic Surgery, the Affiliated Dongnan Hospital of Xiamen University, 269 Huazhong Road, 363000 Zhangzhou, Fujian, PR China; Orthopaedic Trauma Center of the 175th Hospital of PLA, 363000 Zhangzhou, Fujian, PR China
| | - K-J Lian
- Department of Orthopaedic Surgery, the Affiliated Dongnan Hospital of Xiamen University, 269 Huazhong Road, 363000 Zhangzhou, Fujian, PR China; Orthopaedic Trauma Center of the 175th Hospital of PLA, 363000 Zhangzhou, Fujian, PR China
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Floating knee injuries: Results of treatment and outcomes. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2013; 18:1087-91. [PMID: 24523801 PMCID: PMC3908531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/07/2013] [Accepted: 07/04/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Floating knee, referred to as ipsilateral fractures of the femur and tibia, is usually associated with several complications and mortality. This study was designed to present our experience with treatment of this injury throughout; age, sex, mechanism of injury, associated injuries, method and results of treatment, and complications of floating knee are discussed. MATERIALS AND METHODS This retrospective study was performed between January 2006 and December 2011. All patients with floating knee injuries who were admitted to the referral educational hospitals were included. The information about the 238 cases of floating knee injuries were gathered through the 254,620 trauma files and after excluding 18 patients who died within 6 months, the remaining files were studied and the target information was recorded. RESULTS The most frequent age group was 20-29 years (44.5%). The floating knee injuries were more common in males (85.5%). Type (D) according to "the classification of Letts and Vincent" was observed in 38.9% cases. The most frequent mechanism of injury was car to motorcycles accidents (48.2%). The most common associated injury was pelvic fractures (86.8%). Open reduction and internal fixation was the common type of treatment (70%). The most common early and late complications were knee hemarthrosis in 31 cases (14%) and knee osteoarthritis in 30 cases (13.6%), respectively. Death during the 5 years follow up was due to circulatory disruption, followed by deep vein thrombosis (61%). There was a significant relation between the age and outcomes as it worsens with age (P-value < 0.05). CONCLUSION This study revealed that the complication rate associated with floating knee injuries remained high, regardless of the used treatment regimen and surgeons should focus on reducing complications while treating it.
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