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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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Giordano V, Miura KF, Calegari IT, Pires RE, Freitas A, Altamirano-Cruz MA, Taype D, Giannoudis PV. Simultaneous ipsilateral floating hip and knee: the double floating extremity-a systematic review and proposal of a treatment algorithm. Eur J Trauma Emerg Surg 2023; 49:2057-2069. [PMID: 37160440 DOI: 10.1007/s00068-023-02277-x] [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: 10/10/2022] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To systematically review the currently available existing evidence related to the presentation and management of simultaneous floating hip and knee injuries to identify injury characteristics, treatment strategies, and complications. METHODS Data sources: Relevant articles were identified by searching Medline, PubMed, and Google Scholar databases with no language restrictions. Manual searches of other relevant databases (SciELO and grey literature databases) and reference lists of primary articles found from initial searches were also conducted. STUDY SELECTION All types of study designs published from January 1st, 2000 to October 1st, 2022 involving skeletally mature patients with simultaneous floating hip and knee injuries were included. DATA EXTRACTION Basic information and specific injury-related information were collected. RESULTS Eight case reports were included. No study adequately reported the case with sufficient detail to allow other investigators to make inferences, nor was the result properly calculated, nor was the follow-up considered adequate for adequate functional assessment to occur in 80% of the studies. CONCLUSION The exact treatment strategy and the follow-up time are not uniform across the included studies; therefore, they are not sufficient to adequately recommend surgical approach, timing of fixation, and fixation method. Our findings warrant the need for better documentation and reporting information about the mode of treatment of simultaneous floating hip and knee injuries.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° Andar, Gávea, Rio de Janeiro, RJ, 22430-160, Brazil.
- Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, Brazil.
| | - Kenji Fonseca Miura
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° Andar, Gávea, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Igor Tirelo Calegari
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° Andar, Gávea, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | | | - Danilo Taype
- Sección de Trauma, Instituto de Ortopedia y Traumatología Carlos E. Ottolenghi, Hospital Italiano de San Justo Agustin Rocca, Buenos Aires, Argentina
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK
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Wu CM, Liao HE, Lan SJ. Simultaneous bilateral floating knee: A case report. World J Clin Cases 2022; 10:10172-10179. [PMID: 36246811 PMCID: PMC9561588 DOI: 10.12998/wjcc.v10.i28.10172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The phrase “floating knee is a flail knee joint,” referring to ipsilateral femoral and tibial fractures, was first used by Blake and McBryde in 1975. This condition is often caused by a high-energy trauma with often extensive injury to the soft tissues, and is accompanied by life-threatening systemic complications, including head, chest or abdominal injuries and a high incidence of fat embolism. Floating knee is a severe and uncommon injury pattern.
CASE SUMMARY A 27-year-old man sustained multiple injuries when the electric motorcycle he was riding was hit by a van. His injuries included traumatic hypovolemic shock, comminuted and open type II fractures of the left femoral shaft, fracture of the right femoral shaft, comminuted fracture of the bilateral tibial and fibular shaft, and multiple lacerations and abrasions on his forehead, lower lip, neck and limbs. The diagnosis was simultaneous bilateral floating knee complicated with soft tissue injuries. After emergency treatment and the exclusion of life-threating complications, open reduction and internal fixation were successfully performed using plates and screws in the bilateral femoral and tibial shafts.
CONCLUSION Simultaneous bilateral floating knee is a rare and severe injury pattern. The treatment is challenging, and complications. We present a case report of a young adult who suffered from bilateral floating knees during road traffic accident. We also offer our treatment experience of this complex injury and review past literature.
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Affiliation(s)
- Chi-Ming Wu
- Department of Orthopaedic, Jen-Ai Hospital, Taichung 42481, Taiwan
- Department of Orthopaedic, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
| | - Hung-En Liao
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
| | - Shou-Jen Lan
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- School of Medical Science, Putian University, Putian 351100, Fujian Province, China
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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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Barzen S, Buschbeck S, Hoffmann R. [Distal femoral fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:507-517. [PMID: 35725933 DOI: 10.1007/s00113-022-01197-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
CLINICAL ISSUE Fractures of the distal femur represent rare but serious injuries with a high 1‑year mortality. An increasingly older patient population requires adapted treatment concepts. STANDARD TREATMENT PROCEDURE Surgical treatment using angular stable plating and retrograde nailing is the standard procedure. Conservative treatment is only indicated in cases of low demands and high perioperative risks of the patient. TREATMENT INNOVATIONS Primary double plate osteosynthesis and primary implantation of a distal femoral replacement represent new treatment procedures and show promising initial results in the collective of geriatric patients. DIAGNOSTIC WORK-UP Conventional radiographs in 2 planes and computed tomography with multiplanar and 3D reconstructions should be performed to enable an adequate assessment of the indications and treatment planning. PERFORMANCE Nonunion rates of plate and nail osteosyntheses range from 4% to 10%. No significant differences in long-term results can be observed. The results regarding double plate osteosynthesis and distal femoral replacement so far do not show any disadvantages compared to the existing procedures but there is still insufficient data for general recommendations. ASSESSMENT Complex fractures with extensive reconstructive procedures and treatment by distal femoral replacement should be performed in specialized centers. PRACTICAL RECOMMENDATIONS The gold standard is still surgical treatment by means of minimally invasive angular stable plate or retrograde nail osteosynthesis. Complex fracture forms require individual treatment planning considering all currently available treatment options.
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Affiliation(s)
- S Barzen
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und orthopädische Chirurgie, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland.
| | - S Buschbeck
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und orthopädische Chirurgie, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
| | - R Hoffmann
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und orthopädische Chirurgie, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
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Peng C, Ren G, Dou M, Yuan B, Wu D. Minimally invasive plate osteosynthesis for complex comminuted bone fractures in the Fraser's type II floating knee: a case report. Eur J Med Res 2022; 27:31. [PMID: 35236403 PMCID: PMC8889746 DOI: 10.1186/s40001-022-00649-4] [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] [Received: 08/25/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Floating knee type IIC, according to Fraser’s classification, is an uncommon severe injury that typically occurs in polytrauma. In such cases, intra-articular fracture and the high degree of comminution and deformity of the mid-distal femur make fixation challenging. The purpose of this study was to demonstrate that minimally invasive plate osteosynthesis (MIPO) technology can simplify these complex problems and improve patient prognosis. Case presentation A 38-year-old man injured his left leg in a car accident, causing pain, swelling, deformity, and limited mobility on his left knee and thigh, and two small open wounds were noted mainly of the anterior aspect of the mid-distal thigh. Physical examination and computed tomography angiography of the lower limb confirmed that there was no damage to the neurovascular system. The clinical diagnosis was closed intra-articular fracture of the proximal tibia, open intra-articular fracture of the distal femur with extension to the diaphysis, and a patellar fracture on the ipsilateral knee. The treatment strategy involved a locking plate system applying MIPO technology. Postoperative evaluation of the patient was satisfactory, with immediate functional exercise, full weight-bearing after three months, and return to daily activity without pain. Final follow-up taken 3 years after surgery showed good lower limb alignment and complete plasticity of the bone structure, by which time the patient showed good limb function. Conclusions Minimally invasive techniques can provide a simple and effective treatment for some complex fractures.
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Affiliation(s)
- Chuangang Peng
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun, 130041, People's Republic of China
| | - Guangkai Ren
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun, 130041, People's Republic of China
| | - Minghan Dou
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun, 130041, People's Republic of China
| | - Baoming Yuan
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun, 130041, People's Republic of China.
| | - Dankai Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun, 130041, People's Republic of China.
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Raju S, Singhi PK, M C, V S, Shanmugasundaram S, Singhi PK. Floating knee injuries - An analytical study using a conglomerated comprehensive classification. Injury 2021; 52:3091-3098. [PMID: 34275642 DOI: 10.1016/j.injury.2021.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Floating knee injuries are complex high velocity injuries with a simultaneous breach of skeletal integrity both above and below the knee joint. Intraarticular fractures, severe comminution, soft tissue insult, associated other skeletal and systemic injuries have been the most common factors influencing the outcome. With our previous experience we framed a conglomerated comprehensive classification, which includes important prognosticating factors that influences the outcome. Aim of this study is to analyse the efficacy of this classification system for floating knee injury by studying the duration of hospitalisation, number of procedures required for completion of treatment, prognosticating functional outcomes and complications. METHODS This classification is a conglomeration of the existing standard classifications (Fraser, AO, Gustilo and Andersons) along with modifiers like disruption of exensor mechanism M1, avulsion fractures around knee M2 and fractures around hip and ankle joints M3. This classification system was applied to all FKI cases presented to our institution between 2015 and 2018, it has 4 types, 3 subtypes and 3 modifiers. 92 cases were prospectively analysed, the standard treatment protocol was followed as per flowchart, only stable and borderline stable patients were included, functional outcome and recovery of these patients was assessed using modified Karlstrom and Olerud scoring after fracture union. Demographic data, duration of hospitalisation, number of procedures required for completion of treatment, functional outcomes and complications were collected and statistical analysis was done. RESULTS Statistical Analysis showed significant difference between groups I and IV of conglomerated comprehensive classification in the number of days of hospitalisation and number of procedures with p value 0.006 and 0.018 respectively. CONCLUSION Conglomerated comprehensive classification using prognostic factors and existing standard classifications enables better prognostication of these complex floating knee injuries. Identifing and addressing these factors and modifiers included in this classification system will surely improve the outcome. A multicentric study will validate this classifaction in a better way.
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Affiliation(s)
- Sivakumar Raju
- Chief Consultant, Preethi Hospitals Pvt. Ltd, Madurai, Tamilnadu, India
| | - Prahalad Kumar Singhi
- Consultant Arthroscopy & Trauma surgeon, Preethi Hospitals Pvt. Ltd. Madurai, Tamilnadu, India
| | - Chidambaram M
- HOD of dept. of Orthopaedics, Preethi Hospitals Pvt. Ltd. Madurai, Tamilnadu, India
| | - Somashekar V
- Consultant Arthroplasty and Trauma Surgeon, Preethi Hospitals Pvt. Ltd. Madurai, Tamilnadu, India
| | | | - Prahalad Kumar Singhi
- Consultant Arthroscopy & Trauma surgeon, Preethi Hospitals Pvt. Ltd., 50 Melur Main Road, Uthangudi, Madurai, Tamilnadu, India 625107.
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Acute Femoral Nailing and Ipsilateral Knee-Spanning External Fixation: Improved Early Stability for Floating Knee Injuries Involving the Tibial Plateau. J Orthop Trauma 2021; 35:e258-e262. [PMID: 32898080 DOI: 10.1097/bot.0000000000001944] [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] [Accepted: 08/25/2020] [Indexed: 02/02/2023]
Abstract
Ipsilateral femoral shaft and tibial plateau fractures, termed a "floating knee," are rare and challenging injuries. There is limited literature guiding the operative technique and the outcomes associated with these injuries. The author's preferred technique is early intramedullary of the femoral shaft fracture with knee-spanning external fixation of any length unstable plateau fractures in the same operative setting. Early fixation of the femur fracture allows for improved hemodynamic and inflammatory stability. External fixation of the tibial plateau restores length and alignment and allows for soft tissue rest until definitive fixation. The purpose of this study is to describe this operative technique and determine the infection rate and complications requiring return to the operating room in patients with femoral shaft fractures and length unstable plateau fractures.
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Comparison of functional outcomes among subtypes of Fraser's type Ⅱ floating knee. Chin J Traumatol 2021; 24:25-29. [PMID: 33339679 PMCID: PMC7878454 DOI: 10.1016/j.cjtee.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 10/28/2020] [Accepted: 11/20/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement (Fraser's type Ⅱ). This study aims to evaluate and compare the functional outcomes among different Fraser's type Ⅱ floating knee injuries after surgical management. METHODS Twenty-seven patients with Fraser's type Ⅱ floating knee injuries (54 fractures) between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser's floating knee classification into three different groups as type ⅡA (ipsilateral femoral shaft and tibial intra-articular involvement, n = 11), type ⅡB (ipsilateral tibial shaft and femoral intra-articular involvement, n = 9) and type ⅡC (both femoral and tibial intra-articular involvement, n = 7). The differences among the groups were evaluated and compared. The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score (KOOS) which covers 5 subscales of pain, other symptoms, activities of daily living, sports and recreation, and quality of life. The result was also compared with standardized age-sex matched healthy population using paired samples t-test. RESULTS All the patients were male, and the injury mechanism was solely roadside accident. The mean age was 29.8 years and injury severity score 17.9 (comparable in all the three groups). Most injuries were observed on the right side (20 cases, 74.1%). Based on paired samples t-test, the KOOS score of patients with Fraser's type ⅡA was found to be better than that of type ⅡB and type ⅡC. Compared with the reference age-sex matched control group, patients with Fraser's type ⅡB and ⅡC fractures had significantly lower mean score in all KOOS subscales (all p < 0.01). However, Fraser's type ⅡA only revealed significant difference regarding the subscales of activities of daily living (p < 0.0001), sports and recreation (p < 0.0001), and quality of life (p < 0.0001). CONCLUSION The results of this study show that patients with Fraser's type ⅡA fractures had a better functional outcome as compared to those with type ⅡB and ⅡC fractures. This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.
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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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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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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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Abstract
BACKGROUND The term "floating" is used in orthopedic literature to describe certain patterns of skeletal injuries that share one common character which is disruption and discontinuity of bones above and below a joint. The first time used in orthopedic literature being in late 1970 to describe a type of elbow injury. Later the word was used increasingly and applied to a variety of injuries affecting the knee, shoulder, hip, forearm, hand, and ankle. Currently, there are about 12 different skeletal injuries described as floating. OBJECTIVES The aim of this article was to define the term "floating" used in traumatic orthopedics and to discuss its history, mechanism of injury in each region, treatment and outcomes based on the currently available literature. As there were many separate articles describing different sites of floating injuries, this review aimed to summarize all floating injuries into 1 article.
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Affiliation(s)
| | | | - Ying Qin
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Heterotopic ossification around the knee after tibial nailing and ipsilateral antegrade and retrograde femoral nailing in the treatment of floating knee injuries. INTERNATIONAL ORTHOPAEDICS 2018; 42:1379-1385. [DOI: 10.1007/s00264-018-3845-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
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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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Chen AT, Vallier HA. Noncontiguous and open fractures of the lower extremity: Epidemiology, complications, and unplanned procedures. Injury 2016; 47:742-7. [PMID: 26776462 DOI: 10.1016/j.injury.2015.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/10/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Isolated fractures of the lower extremity are relatively common injuries while multifocal injuries resulting from high-energy trauma are less frequently encountered. Our objectives are to characterise patients who sustained multiple noncontiguous fractures and open fractures of the lower extremity, report the incidence of major complications, and identify factors that may contribute to complications and unplanned re-operations. PATIENTS AND METHODS A retrospective review of patients was performed at a Level 1 trauma centre from 2000 to 2013. Patients who sustained two or more noncontiguous operative fractures in an ipsilateral lower extremity, with at least one open fracture were included. Noncontiguous was defined as fractures in the same lower limb that were not in continuity on preoperative radiographs or intra-operatively. Demographic, injury characteristics, and hospitalisation data were collected. Primary outcomes included non-union, deep infection, and the need for unplanned surgeries. RESULTS 257 patients sustained a total of 876 lower extremity fractures with an average of 1.7 open and 2.7 operative fractures in the qualifying limb. Ninety-nine patients (38.5%) sustained bilateral lower extremity injuries. Following their initial stay, 22.6% of patients had planned procedures (definitive fixation, skin, or planned bone grafting). Nearly half (45.9%) required one or more unplanned re-operation. Complications included deep infections (19.5%), non-unions (19.5%), and mal-unions (2.7%). 17.5% of the patients had at least one procedure for removal of painful implants. A deep infection was predictive of having a non-union (odds ratio, OR 7.5). The presence of a Gustilo-type IIIB/IIIC (OR 24.6/16.0) fracture was predictive of having a deep infection. After excluding painful implant removal, a type IIIB fracture was associated with an unplanned procedure (OR 13.8). CONCLUSIONS Patients with multiple non-contiguous lower extremity injuries associated with open fractures can expect complications including non-unions, deep infections, and painful implants. Nearly half of the patients will need further operative treatment.
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Affiliation(s)
- Andrew T Chen
- Resident Physician, Department of Orthopaedic Surgery, MetroHealth Medical Center, Affiliated with Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, United States.
| | - Heather A Vallier
- Professor of Orthopaedic, Surgery Department of Orthopaedic Surgery, MetroHealth Medical Center, Affiliated with Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, United States
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Singaravadivelu V, Bassetty KC, Balakrishnan TM, Lankaram JJ. Management of Pipkin Type-III Femoral Head Fracture and Ipsilateral Open Floating Knee with Extensor Apparatus Injury: A Case Report. JBJS Case Connect 2016; 6:e19. [PMID: 29252725 DOI: 10.2106/jbjs.cc.o.00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A twenty-eight-year-old man presented with a Pipkin type-III femoral head fracture and open floating knee injury. Initially debridement was performed, during which the extensor apparatus could not be salvaged. The top priority in management of the floating knee was achievement of adequate soft-tissue coverage followed by skeletal stabilization as staged procedures. Because the femoral head was split, dislocated, comminuted, and deemed nonreconstructible, arthroplasty was considered the best option. The extensor mechanism damage was addressed by reconstruction using an iliotibial tract flap. CONCLUSION This case report is presented for its uniqueness, the management protocol, and the difficulties encountered during the multistage treatment.
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Affiliation(s)
- V Singaravadivelu
- Institute of Orthopaedics and Traumatology (V.S., K.C.B.) and Department of Plastic and Reconstructive Surgery (T.M.B., J.J.L.), Madras Medical College and Rajiv Gandhi Government General Hospital, Tamil Nadu, India
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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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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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Abstract
OBJECTIVES To 1) review the existing evidence for early mobilization of the critically ill patients in the ICU with polytrauma; 2) provide intensivists with an introduction to the biomechanics, physiology, and nomenclature of injuries; 3) summarize the evidence for early mobilization in each anatomic area; and 4) provide recommendations for the mobilization of these patients. DATA SOURCES A literature search of the MEDLINE and EMBASE databases for articles published in English between 1980 and 2011. STUDY SELECTION Studies pertaining to physical therapy and rehabilitation in trauma patients were selected. Articles were excluded if they dealt with pediatrics, geriatrics, burn injuries, isolated hand injuries, chronic (i.e., not acute) injuries, nontraumatic conditions, and pressure/decubitus ulcers, were in a language other than English, were published only in abstract form, were letters to the editor, were case reports, or were published prior to 1980. DATA EXTRACTION Reviewers extracted data and summarized results according to anatomical areas. DATA SYNTHESIS Of 1,411 titles and abstracts, 103 met inclusion criteria. We found no articles specifically addressing the rehabilitation of polytrauma patients in the ICU setting or patients with polytrauma in general. We summarized the articles addressing the role of mobilization for specific injuries and treatments. We used this evidence, in combination with biologic rationale and physician and surgeon experience and expertise, to summarize the important considerations when providing physical therapy to these patients in the ICU setting. CONCLUSIONS There is a paucity of evidence addressing the role of early mobilization of ICU patients with polytrauma and patients with polytrauma in general. Evidence for the beneficial role of early mobilization of specific injuries exists. Important considerations when applying a strategy of early physical therapy and mobilization to this distinctive patient group are summarized.
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Akinyoola AL, Yusuf MB, Orekha O. Challenges in the management of floating knee injuries in a resource constrained setting. Musculoskelet Surg 2013; 97:45-9. [PMID: 23307508 DOI: 10.1007/s12306-012-0239-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022]
Abstract
Floating knee injuries pose major challenges in management. There is little information on the patterns of these injuries and the challenges of managing them in our setting. Patients with floating knee injuries who were seen and treated over a 5-year period at our center were retrospectively reviewed. The patterns of the injuries, associated injuries, methods of management and factors that influenced the outcome were analyzed. Twenty-five patients, consisting of 19 males and 6 females with a mean age of 33.4 ± 16.04 years, satisfied the study criteria. All were caused by road traffic injuries, motor cycle crashes accounting for 19 (76%). Twenty-two (88%) injuries were Blake and McBryde type 1, while 3 (12%) were of type 2A. Thirty-two percent of the patients had surgical fixation of both fractures, while 40% of the patients had both fractures managed non-operatively. Non-operative management strongly correlated with development of malunion. The results of management of floating injuries in our setting are not satisfactory. Orthopedic and trauma care should be made accessible to those requiring it.
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Affiliation(s)
- A L Akinyoola
- Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
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Bishop J, Agel J, Dunbar R. Predictive factors for knee stiffness after periarticular fracture: a case-control study. J Bone Joint Surg Am 2012; 94:1833-8. [PMID: 23243676 DOI: 10.2106/jbjs.k.00659] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knee stiffness is an important complication after periarticular fracture, but a systematic evaluation of risk factors for this complication and outcomes of treatment has not been undertaken, to our knowledge. The aims of this study were to evaluate risk factors for knee stiffness requiring manipulation after periarticular fracture and to document the clinical outcomes of the manipulation. METHODS This study was designed as a case-control study in which patients requiring manipulation under anesthesia after periarticular fracture were compared with those who did not require manipulation. Using billing data from a regional level-I trauma center, we identified twenty-four knees requiring manipulation for refractory stiffness over a six-year period. These were matched, on the basis of the AO/OTA classification, with forty-three control knees that did not develop stiffness requiring manipulation. Descriptive statistics were used for frequency and mean analysis. RESULTS Univariate analysis revealed that extensor mechanism disruption (chi square = 0.05), fasciotomy (chi square = 0.020), wounds requiring ongoing management and precluding knee motion (p = 0.001), and the need for more than two surgical procedures to achieve definitive fracture fixation and soft-tissue coverage (p = 0.003) all placed patients at increased risk for knee stiffness requiring manipulation. The mean improvement in knee motion following all procedures targeting knee stiffness was 62°. Mean final flexion was significantly less in the case group (107°) compared with the control group (124°; p=0.01). CONCLUSIONS To our knowledge, this is the first study to systematically evaluate the risk factors for knee stiffness after periarticular fracture and document the outcomes of manipulation under anesthesia. It demonstrates that injury characteristics that delay or prevent postoperative knee motion place patients at increased risk for refractory knee stiffness. Although knee motion remains compromised, late surgery aimed at improving knee motion leads to improvements in flexion
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Affiliation(s)
- Julius Bishop
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA 94063, USA.
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24
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Hegazy AM. Surgical management of ipsilateral fracture of the femur and tibia in adults (the floating knee): postoperative clinical, radiological, and functional outcomes. Clin Orthop Surg 2011; 3:133-9. [PMID: 21629474 PMCID: PMC3095784 DOI: 10.4055/cios.2011.3.2.133] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 08/23/2010] [Indexed: 01/05/2023] Open
Abstract
Background This study evaluated the outcomes of surgical management of ipsilateral femoral and tibial fractures in adults. Methods Fifteen patients (13 men, 2 women; mean age, 34.8 years; range, 18 to 65 years) were enrolled in this study. The fractures types were classified according to the classification by Fraser et al. as follows: type I (5), type IIa (3), IIb (4), IIc (3). Femur fractures were treated using locked intramedullary nails, plate-screws, or dynamic condylar screws, and tibia fractures were treated with an external fixator (in open fractures), or plate-screws, and locked intramedullary nailing. The mean follow-up duration was 2.2 years (range, 1.3 to 4 years). Results The extent of bony union according to the Karlstrom criteria was as follows: excellent, 8; good, 4; acceptable, 2; poor, 1. Conclusions The associated injuries and type of fracture (open, intra-articular, comminution) are prognostic factors in a floating knee. The best management of the associated injuries for good final outcome involves intramedullary nailing of both the fractures and postoperative rehabilitation.
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Affiliation(s)
- Alaa M Hegazy
- Orthopedic Surgery Department, Zagazig University Faculty of Medicine, Zagazig, Egypt.
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25
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Mallina R, Kanakaris NK, Giannoudis PV. Peri-articular fractures of the knee: an update on current issues. Knee 2010; 17:181-6. [PMID: 19945287 DOI: 10.1016/j.knee.2009.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 10/26/2009] [Accepted: 10/29/2009] [Indexed: 02/02/2023]
Abstract
Peri-articular fractures of the knee in the young and elderly pose several management dilemmas. Over the last decade enormous interest has been generated in various fixation modalities, none proving to be an ideal stabilisation method. The problem is compounded by a lack of well-designed studies comparing various treatment options. In this article, the issues surrounding the diagnostic and management strategies of peri-articular fractures of the knee are discussed.
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Affiliation(s)
- Ravi Mallina
- Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, School of Medicine, University of Leeds, Clarendon Wing Level A, Great George Street, Leeds, United Kingdom.
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Rethnam U, Yesupalan RS, Nair R. Impact of associated injuries in the floating knee: a retrospective study. BMC Musculoskelet Disord 2009; 10:7. [PMID: 19144197 PMCID: PMC2630294 DOI: 10.1186/1471-2474-10-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 01/14/2009] [Indexed: 11/30/2022] Open
Abstract
Background Floating knee injuries are usually associated with other significant injuries. Do these injuries have implications on the management of the floating knee and the final outcome of patients? Our study aims to assess the implications of associated injuries in the management and final outcome of floating knee. Methods 29 patients with floating knees were assessed in our institution. A retrospective analysis of medical records and radiographs were done and all associated injuries were identified. The impact of associated injuries on delay in initial surgical management, delay in rehabilitation & final outcome of the floating knee were assessed. Results 38 associated injuries were noted. 7 were associated with ipsilateral knee injuries. Lower limb injuries were most commonly associated with the floating knee. Patients with some associated injuries had a delay in surgical management and others a delay in post-operative rehabilitation. Knee ligament and vascular injuries were associated with poor outcome. Conclusion The associated injuries were quite frequent with the floating knee. Some of the associated injuries caused a delay in surgical management and post-operative rehabilitation. In assessment of the final outcome, patients with associated knee and vascular injuries had a poor prognosis. Majority of the patients with associated injuries had a good or excellent outcome.
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Affiliation(s)
- Ulfin Rethnam
- Department of Orthopaedics, Glan Clwyd Hospital, Bodelwyddan, UK.
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Oñorbe F, Ferrer-Santacreu E, Rodríguez-Merchán E. Rodilla flotante: revisión retrospectiva de 15 casos tratados durante un periodo de 5 años. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1888-4415(08)74835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Oñorbe F, Ferrer-Santacreu E, Rodríguez-Merchán E. The floating knee: retrospective review of 15 cases treated over a 5-year period. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1988-8856(08)70110-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
BACKGROUND To perform a descriptive study of the course, treatment decisions, complications, and outcome of patients suffering simultaneous ipsilateral fractures of the femur and pelvis. METHODS Medical records and radiographs of 57 patients were reviewed retrospectively. RESULTS The average follow-up was 28 months. Fifteen patients (26%) had an acetabular fracture, 17 (30%) had a pelvic ring fracture, and 25 (44%) had both fractures concomitant with the ipsilateral femoral fracture. Eighty percent of acetabular fractures and 55% of pelvic ring fractures were treated surgically. Femur fractures underwent operation in 94% of cases. When multiple operative settings were used, the femur fracture was always fixed at the first operation. Complications included deep venous thrombosis (DVT) (12%), heterotopic ossification (HO) (34%), femoral head avascular necrosis (AVN) (2%), osteoarthritis (OA) (16%), and traumatic sciatic nerve palsy (33%). At least partial nerve palsy resolution occurred in 53% of patients. CONCLUSIONS Ipsilateral injuries to the femur and the pelvis or acetabulum ("floating hip") are severe injuries usually caused by high-energy trauma. The acetabulum and pelvic ring are more commonly fractured together than either alone. The femur fracture will most commonly be addressed first, as in 65% of our cases in which both components were addressed at the same setting, and 100% of cases in which they were addressed in separate settings. Delays of surgery were common because of severity of systemic trauma. Surgeons should be aware of the high incidence of sciatic nerve palsy as well as treatment options and potential complications associated with this devastating combination of injuries.
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Marco FAD, Rozim AZ, Piedade SR. Estabilidade articular do joelho no quadro do "joelho-flutuante". ACTA ORTOPEDICA BRASILEIRA 2008. [DOI: 10.1590/s1413-78522008000100006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Neste trabalho, 22 pacientes com fraturas ipslaterais do fêmur e da tíbia ("joelho flutuante") tratados cirurgicamente foram convocados para reavaliação. Com seguimento mínimo de 4 meses, 17 pacientes compareceram e foram reavaliados através de exame físico, radiológico, escala de Lysholm e o escore de Kärlstron. As fraturas foram classificadas quanto ao grau de exposição (Gustillo e Andersen), cominuição (AO) e o "joelho-flutuante" (Fraser). Doze pacientes (70,6%) apresentaram alterações objetivas no exame físico do joelho. A instabilidade articular foi a alteração mais encontrada, presente em oito casos (47%), seguida da restrição de movimento em sete pacientes (41,2%). A instabilidade anterior foi diagnosticada em cinco casos (29,4%), sendo três associados à instabilidade em varo. A instabilidade posterior estava presente em dois pacientes (11,8%), ambos associados com instabilidade em varo. Um paciente apresentou instabilidade periférica em varo e valgo, associada à restrição importante da flexão do joelho. As presença de fraturas intra-articulares, fraturas expostas do fêmur cursaram com maior incidência de restrição do arco de movimento. Nesta casuística os resultados obtidos reforçam a necessidade da avaliação sistemática da estabilidade articular do joelho, visto que o quadro de "joelho flutuante" está freqüentemente associado à lesão cápsulo-ligamentar desta articulação.
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Lin CC, Huang CC, Hsu HC. Rupture of anterior cruciate ligament associated with fractures of ipsilateral femoral shaft and neck. Orthopedics 2008; 31:87. [PMID: 19292151 DOI: 10.3928/01477447-20080101-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Chien-Chung Lin
- Department of Orthopedic Surgery, China University Medical Hospital, Taichung, Tawain
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Rethnam U, Yesupalan RS, Nair R. The floating knee: epidemiology, prognostic indicators & outcome following surgical management. J Trauma Manag Outcomes 2007; 1:2. [PMID: 18271992 PMCID: PMC2241764 DOI: 10.1186/1752-2897-1-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 11/26/2007] [Indexed: 12/19/2022]
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.
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Affiliation(s)
- Ulfin Rethnam
- Department of Orthopaedics, Glan Clwyd Hospital, Bodelwyddan, UK.
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Ng ABY, Soong VKY, Maguire MP, Hopgood P, Shepard GJ. Concomitant ipsilateral floating hip and floating knee injuries: a unique injury and review of the literature. Int J Clin Pract 2007; 61:1585-7. [PMID: 17596186 DOI: 10.1111/j.1742-1241.2006.00868.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Levy BA, Zlowodzki MP, Graves M, Cole PA. Screening for extermity arterial injury with the arterial injury with the arterial pressure index. Am J Emerg Med 2005; 23:689-95. [PMID: 16140180 DOI: 10.1016/j.ajem.2004.12.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Accepted: 12/22/2004] [Indexed: 11/24/2022] Open
Abstract
Certain extremity injuries presenting to the ED or Trauma Unit warrant increased suspicion for underlying arterial trauma. Such injuries include knee dislocations, displaced medial tibial plateau fractures and other displaced bicondylar fractures around the knee, open or segmental distal femoral shaft fractures, floating joints, gunshot wounds in proximity to neurovascular structures, or mangled extremities. Once the diagnosis of arterial trauma is made, a multi-disciplinary approach is warranted. The diagnostic strategies for vascular injury have undergone an evolution over the past 2 decades. One and a half percent to 4.6% of patients hospitalized with blunt extremity trauma have associated vascular compromise [Bunt TJ, Malone JM, Moody M, et al. Am J Surg 1990;160(2):226-8; Reid JD, Weigelt JA, Thal ER, et al. Arch Surg 1988;123(8):942-6; Applebaum R, Yellin AE, Weaver FA, et al. Am J Surg 1990;160(2):221-4; discussion 224-5; Dennis JW, Frykberg ER, Veldenz HC, et al. J Trauma 1998;44(2):243-52; discussion 242-3]. An efficient and effective evidence-based approach to diagnosing vascular injury is necessary, as the difficulty in diagnosis, the multiplicity of diagnostic strategies, the limited time frame in which to initiate appropriate treatment, the limb threatening complications of a missed diagnosis, and the increased awareness of health care expenditures make this entity an intimidating diagnostic challenge [Johansen K, Lynch K, Paun M, et al. J Trauma 1991;31(4):515-9; discussion 519-22; Lynch K, Johansen K. Ann Surg 1991;214(6):737-41; Walker ML, Poindexter Jr JM, Stovall I. Surg Gynecol Obstet 1990;170(2):97-105; Kendall RW, Taylor DC, Salvian AJ, et al. J Trauma 1993;35(6):875-8]. The purpose of this article is to present an evidence-based algorithm for patients who present with either arterial injury or a high-risk of arterial injury. A diagnostic algorithm will be presented, and the rationale for diagnostic interventions will be discussed in the context of current medical literature.
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Affiliation(s)
- Bruce A Levy
- Sports and Knee Injuries, Regions Hospital, University of Minnesota, St Paul, MN 55101, USA
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35
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Dwyer AJ, Paul R, Mam MK, Kumar A, Gosselin RA. Floating knee injuries: long-term results of four treatment methods. INTERNATIONAL ORTHOPAEDICS 2005; 29:314-8. [PMID: 16132984 PMCID: PMC3456641 DOI: 10.1007/s00264-005-0679-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Accepted: 05/09/2005] [Indexed: 11/27/2022]
Abstract
One hundred twenty-four consecutive patients with true floating knee injury presented between 1987 and 2001. They were treated with non-operative, operative (external fixation and intramedullary nailing) and combined modalities. Sixty patients were followed up, at an average of 7.2 years, for age, gender, type of trauma and fracture; time to fracture union and time to mobilisation. Complications that were encountered and return to normal activities were recorded. Better and comparable union rates of fractures, earlier return to activities and higher excellent and good long-term functional results were observed among combined and operative (intramedullary nail) groups. Using combined modalities of treatment is an affordable, practicable and effective approach, especially for a resource-poor environment. External fixation of the fractured femur resulted in a decreased range of movement at the knee due to quadriceps muscle fixation. Fractured tibia, treated by any of the method, did not interfere with patient's joint mobilisation whereas associated injuries did.
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Affiliation(s)
- A J Dwyer
- Department of Orthopaedic Surgery, Christian Medical College and Hospital, Ludhiana, Panjab, 141008, India.
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Miralles-Muñoz F, Lizaur-Utrilla A, Bustamante-Suárez D. La rodilla flotante: estudio retrospectivo de 41 casos. Rev Esp Cir Ortop Traumatol (Engl Ed) 2005. [DOI: 10.1016/s1888-4415(05)76313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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