Floating knee injuries – An analytical study using a conglomerated comprehensive classification

Abstract

PurposeFloating 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. MethodsThis 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. ResultsStatistical 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. ConclusionConglomerated 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.