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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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Wang J, Luo L, Zhao Z, Huang B. Floating knee with rupture of popliteal artery: A case report and literature review. Asian J Surg 2023; 46:4038-4039. [PMID: 37147262 DOI: 10.1016/j.asjsur.2023.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023] Open
Affiliation(s)
- Jun Wang
- Department of Joint Surgery, People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Liang Luo
- Department of Joint Surgery, People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Zhengming Zhao
- Department of Joint Surgery, People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Bin Huang
- Department of Joint Surgery, People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China.
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Miller B, Phillips M, Krech L, Biberstein B, Parker J, Pounders S, Fisk C, Chapman AJ, Moffitt G. Outcomes of simultaneous versus staged intramedullary nailing fixation of multiple long bone lower extremity fractures. Injury 2023:110831. [PMID: 37236854 DOI: 10.1016/j.injury.2023.05.062] [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: 10/07/2022] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Repair of multiple lower extremity long bone fractures with intramedullary nail (IMN) fixation is associated with significant cardiopulmonary burden and may result in mortality. These patients are at an increased risk for fat embolism syndrome, pulmonary embolism, Acute Respiratory Distress Syndrome (ARDS), and pneumonia. No standardized guidelines exist to guide treatment of these patients. Further, there is a paucity of data regarding the risk of simultaneous versus staged fixation of multiple long bone fractures that includes both tibial and femoral injuries, as patients with multiple concomitant fractures are often excluded from relevant analyses. Our level one trauma center aimed to identify whether simultaneous fixation, defined by definitive fixation of multiple lower extremity long bone fractures during one operative event, led to increased cardiopulmonary complications as compared to a staged approach, defined as multiple operations to reach definitive fixation. PATIENTS AND METHODS The Michigan Trauma Quality Improvement Program (MTQIP) database from 35 Level I and II trauma centers was queried to identify patients from January 2016 - December 2019. The primary outcome was incidence of cardiopulmonary complications for staged and simultaneous IMN fixation. RESULTS We identified 11,427 patients with tibial and/or femoral fractures during the study period. 146 patients met the inclusion criteria of two or more fractures treated with IMN fixation. 118 patients underwent simultaneous IMN fixation, and 28 patients received staged IMN fixation. There were no significant differences in injury severity score (ISS), demographics, pre-existing conditions, and cardiopulmonary complications between the two groups. There was a statistically significant difference in hospital length of stay (LOS) (p = 0.0012). The median hospital LOS for simultaneous fixation was 8.3 days versus 15.8 days for the staged cohort, a difference of 7.5 days. CONCLUSION This is the largest retrospective study to date examining simultaneous versus staged IMN fixation in patients with multiple long bone lower extremity fractures. In contrast to previous studies, we found no difference in cardiopulmonary complications. Given these findings, patients with multiple long bone lower extremity fractures should be considered for simultaneous IMN, an approach which may decrease hospital LOS.
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Affiliation(s)
- Blake Miller
- Orthopaedic Associates of Muskegon, 260 Jefferson Ave SE Suite 115 Grand Rapids, Michigan, 49503, United States.
| | - Maxwell Phillips
- McLaren Flint Orthopaedic Surgery Residency, 401 South Ballenger Highway Flint, Michigan, 48532, United States
| | - Laura Krech
- Trauma Research Institute, Spectrum Health, 100 Michigan St NE Grand Rapids, Michigan, 49503, United States.
| | - Bryce Biberstein
- Spectrum Health Butterworth Hospital, 100 Michigan St NE Grand Rapids, Michigan, 49503, United States
| | - Jessica Parker
- Spectrum Health, Scholarly Activity and Scientific Support, Spectrum Health Office of Research, 100 Michigan St NE Grand Rapids, Michigan, 49503, United States.
| | - Steffen Pounders
- Trauma Research Institute, Spectrum Health, 100 Michigan St NE Grand Rapids, Michigan, 49503, United States.
| | - Chelsea Fisk
- Trauma Research Institute, Spectrum Health, 100 Michigan St NE Grand Rapids, Michigan, 49503, United States.
| | - Alistair J Chapman
- Trauma Research Institute, Spectrum Health, 100 Michigan St NE Grand Rapids, Michigan, 49503, United States.
| | - Gable Moffitt
- Spectrum Health Butterworth Hospital, 100 Michigan St NE Grand Rapids, Michigan, 49503, United States.
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Aggarwal S, Rajnish RK, Kumar P, Srivastava A, Rathor K, Haq RU. Comparison of outcomes of retrograde intramedullary nailing versus locking plate fixation in distal femur fractures: A Systematic Review and Meta-analysis of 936 patients in 16 studies. J Orthop 2023; 36:36-48. [PMID: 36591439 PMCID: PMC9800249 DOI: 10.1016/j.jor.2022.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background The surgical treatment for distal femur fractures has evolved over time, and it depends upon certain factors; open or closed fracture type, the pattern of fracture, presence of metaphyseal comminution, intra-articular extension, and the bone quality are some of the crucial ones. Both retrograde intramedullary nails (RIMN) and locking plates (LP) can be used for the fixation of these fractures. However, the optimal method among the two devices is still a topic of debate, the superiority of one over the other being unclear. Hence, this systematic review and meta-analysis was conceptualized to compare the outcomes of RIMN with distal femur LP. Methods The primary electronic search was conducted on Medline (PubMed), Scopus, Embase, Cinahl, and Cochrane Library databases for the published literature from the inception to 25th February 2022. The studies compared outcomes of RIMN versus LP fixation of the acute supracondylar or distal femur fracture (AO/OTA type-33A, B, and C) and reported at least one primary (mean fracture union time, complications, implant-related complications, and re-operation rate) or secondary outcome (duration of surgery, intra-operative blood loss, and knee range of motion), were included. Results Six randomized control trials, 2 prospective and 8 retrospective studies with 936 patients with 8 bilateral cases (467: RIMN; 477: LP) were included. Our analysis demonstrated no statistically significant difference in terms of mean fracture union time, overall complications, implant-related complications, re-operation rates, and duration of surgeries. Although a better knee range of motion was seen in the LP group, however, it also showed more nonunion and infection than the RIMN group. Conclusion The present review shows that there are significantly lesser nonunions and infections, in the RIMN group as compared to LP for distal femur fractures, although a better postoperative knee range of motion was seen in the latter. However, in terms of fracture union time, the overall rate of complications, re-operation rates, and duration of surgeries, there is no difference between the two surgical options.
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Affiliation(s)
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prasoon Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Amit Srivastava
- Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Kuldeep Rathor
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rehan Ul Haq
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, India
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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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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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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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Tan SHS, Hong CC, Saha S, Hey HWD, Murphy D, Hui JH. Optimum early orthopaedic surgery in COVID-19 patients. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:250-254. [PMID: 33855321 DOI: 10.47102/annals-acadmedsg.2020317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Si Heng Sharon Tan
- Department of Orthopaedic Surgery, National University Hospital, Singapore
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