The Floating Knee in Pediatric Patients: A Single-Center Retrospective Study From a Referral Center.

Abstract

IntroductionAn ipsilateral fracture of the femur and tibia (also known as floating knee) is a rare injury in pediatric patients. Recent advances rapidly made the use of intramedullary elastic nails the standard of care in the management of long bone fractures, including floating knee injuries, in patients with immature skeletons. Currently, we have observed a trend of fixing both fractured bones, thus improving functional outcomes, and reducing sequelae. The aim of this study was to report our experience in the management and functional outcomes of floating knee injuries in a single trauma-I level center.Materials and methodsThis is a retrospective study of consecutive cases from June 1, 2018, to March 31, 2022, from a single trauma center. Preoperative and postoperative records and radiographs were assessed, including the epidemiological data and characteristics of the fractures type of treatment, mechanism of injury, complications, and functional evaluation at the last follow-up, which was performed according to the criteria described by Karlstrom and Olerud.ResultsTwenty-five patients were included during the four years of study, of which 18 were male (72%), and the mean age was 9.6 years. Overall, 96% of the cases were related to traffic accidents. An analysis of the provided treatment showed that 19 cases (76%) were resolved with surgery on at least of the bones, and six cases were managed with simultaneous orthopedic treatments in both injuries. Excellent outcomes were achieved in 15 cases (60%), good outcomes in three, fair outcomes in five, and poor outcomes in one. Concerning the classification of injuries according to the criteria developed by Letts and Vincent,it was observed that type D was the most frequent one. With regard to exposed bone injuries, 15 cases presented with open fractures. Complications were found in eight (32%) cases, of which five were related to limb discrepancy and three with functional limitations of the knee, with changes in its range of motion. There was also one case of nonunion of the distal tibia.ConclusionTraffic accidents are the main cause of floating knees. Surgical management of the fractures brought satisfactory outcomes and reduced complications. Thus, fixation of injuries is recommended for early return to daily activities and for a reduction in residual complications.