A retrospective study of floating knee injuries and various modalities of operative intervention with outcomes

Abstract

Background: floating knee injuries refers to ipsilateral tibial and femoral shaft fractures with or without involving knee joints articular surface to various extent. This is a high impact injury usually occurs from high velocity RTA. Multiple life-threatening injury to head, chest and abdomen involving multiple soft tissues is a common occurrence with floating knee. Involvement of tibia and femur to variable extent results in huge diversification of fracture patterns and treatment. This study aims at analysis of need for various modes of operative interventions with combination of multiple fixation techniques and their outcome.Methods: This is a retrospective study of 30 cases conducted between 2018 to 2020 with follow-up of 2 years. Study conducted at a tertiary care private hospital. Patients were treated with combination of various implants like external fixator, femoral and tibial plate osteosynthesis, and intramedullary nail as per the fracture pattern. Outcome analysed at the end of study taking in to consideration of type of fracture and implants used in terms of time to union, complications and need for reoperation. Objectively assessed after a 2 year with Karlstrom and Olerud criteria.Results: The mean age of our study population was 32.4 years. The average time for union of femur was 7.5 months, and for tibia is 9.7 months. All thirty patients were involved in road traffic accident. The right side was involved in 24 (80%) patients and left side in 6 (20%) patients. There were 14 Type-I (46.66), 3 Type-IIA (10%), 9 Type-IIB (30%) and 4 Type-IIC (13.33%) Floating knee injuries according to Fraser classification. There were 21 (70%) open in which all patients were with tibia open fractures and 9 (30%) were with closed fractures. Functional assessment was done using Karlstrom and Olerud criteria after complete bony union, which showed excellent results in 8(26.66) patients, good in 10(33.33%), fair in 8 (26.66%) and 4 patients with poor results (13.33%).Conclusions: Floating knee injuries are complex fracture. Needs initial thorough evaluation to roll out other injuries. Early diagnosing and addressing of popliteal artery injuries are limb saving. Initial stabilisation of fractures with external fixator to control damage may follows multiple operative procedures as definitive fixation in many. Anatomical reduction and fixation irrespective of implant with minimal soft tissue insult were proved to be critical. Aggressive rehabilitation process and early joint mobilisation are key to good outcome.