Floating Knee Injuries Research Articles

Knee Instability Following Fractures Around the Knee Joint: Diagnostic Dilemma and Management Challenges.

Knee instability following fractures around the knee joint is not uncommon but is often missed. They present challenges in identifying them during index injury or at follow-up. We share our experience of knee instability following fractures around the knee joint. (1) To identify the pattern of clinically significant knee instability following fractures around the knee joint. (2) To discern the association of fracture morphology with ligamentous disruption. (3) To identify the risk factors for knee ligament injury following fractures around the knee. (4) To recognise the signs of instability in fracture scenarios and their diagnostic pitfalls/management challenges. After appropriate Ethical committee clearance and patient consent, a retrospective analysis of 595 fractures around the knee joint was performed at our institute from 2018 to 2021. After employing the exclusion criteria, a total of 92 cases of ligament injuries were included in the analysis. Seventy-six of them were identified and addressed during the index procedure, and 16 of them presented with delayed instability during fracture healing, treated by appropriate arthroscopic ligament reconstruction. Demographic data, mode of injury, fracture morphology, ligament injury pattern and associated injuries were documented and analysed. Functional outcome was assessed using Lysholm scoring and the International Knee Documentation Committee questionnaire at the final follow-up. The overall incidence of clinically significant knee ligament injury was 15.46%. Among the 76 acute cases, 8 were ACL avulsions, 47 were PCL avulsions, 9 were MCL injuries, 2 were LCL injuries, and 10 had MLKI treated by arthroscopic/open techniques. Out of the 16 cases that presented late, 6 had ACL injuries, 2 had LCL injuries, and 8 of them had a multi-ligamentous knee injury. With respect to the fracture pattern, 56 (60.9%) had tibia fractures, 24 (26.1%) had femur fractures, 3 (3.3%) of them had patella fractures, and 9 (9.8%) had floating knee injuries. The mean Lysholm score was 85.7±9.8. 19.6% (n = 18) had excellent outcome, 46.7% (n = 43) had good outcome, 23.9% (n = 22) had fair outcome and 9.8% (n = 9) had poor outcome. Knee instability following fractures around the knee is not uncommon, one out of six fractures may have significant instability. Identifying and addressing is key for a satisfactory outcome and to avoid its sequalae.

TO EVALUATE THE FUNCTIONAL OUTCOME IN PATIENTS WITH FLOATING KNEE WHO UNDERWENT MAGNETIC RESONANCE IMAGING

Objective: The incidence of floating knee injuries has traditionally been underestimated. However, with the increased use of magnetic resonance imaging (MRI) and arthroscopy, their frequency has risen. There is a crucial need to classify this complex injury pattern by also considering associated soft-tissue injuries. Soft-tissue injuries might be missed during clinical examination due to tenderness and swelling but can be detected through immediate MRI scans. This study aimed to evaluate the functional outcomes of patients with floating knee injuries who underwent MRI for soft tissue injuries. Methods: This study was conducted at a tertiary care center from February 2021 to January 2024. The study involved 100 patients with floating knee injuries who underwent MRI assessments for soft-tissue injuries. Follow-ups were scheduled at 1 month, 3 months, 6 months, and 1 year, with a maximum follow-up duration of 2½ years. The outcomes of floating knee injuries were assessed using the Karlstrom Olerud criteria. Results: Among 100 patients with floating knee injuries who underwent MRI, 72 had meniscus or ligament injuries, and nine had patellar fractures with extensor mechanism rupture. According to the Karlstrom Olerud criteria, seven patients had excellent outcomes, 46 had good outcomes, 33 had fair outcomes, and six had poor outcomes. Eight patients were lost to follow-up. Conclusion: Our aim is to ensure timely and accurate treatment by thoroughly addressing all associated injuries, including often-overlooked ligament damage around the knee. To improve clinical outcomes, we recommend a multidisciplinary approach involving various specialists in the care of these patients.

THE MANCHESTER PATTERN KNEE-SPANNING EXTERNAL FIXATOR: A MECHANICAL COMPARISON WITH TRADITIONAL EXTERNAL FIXATOR CONSTRUCTS

IntroductionKnee dislocations, vascular injuries and floating knee injuries can be initially managed by a external fixator. Fixator design constructs include the AO pattern and the Diamond pattern. However, these traditional constructs do not adhere to basic principles of external fixation. The Manchester pattern knee-spanning external fixator is a new construct pattern, which uses beam loading and multiplanar fixation. There is no data on any construct pattern. This study compares the stability of these designs.Materials & MethodsHoffman III (Stryker, USA) external fixation constructs were applied to articulated models of the lower limb, spanning the knee with a diamond pattern and a Manchester pattern. The stiffness was loaded both statically and cyclically with a Bose 3510 Electroforce mechanical testing jig (TA Instruments). A ramp to load test was performed initially and cyclical loading for measurement of stiffness over the test period. The results were analysed with a paired t-test and ANOVA.ResultsThe mean stiffness with the diamond pattern fixator was significantly less stiff than the Manchester pattern fixator – by a factor of 3 (40N/mm vs 115N/mm). Displacement increased in all patterns over simulated loading equating to six weeks. The diamond pattern demonstrated a 50%% increase in displacement over time. The Manchester pattern demonstrated only 20% increase in displacement over time. These are all statistically significant (p<0.01)ConclusionsThe aim of an external fixator in knee dislocations and vascular injuries is to provide stability, prevent displacement and protect repairs. Vascular injuries often require fixation for several weeks to protect a repair. The Manchester pattern, applying the principles of external fixation, provides a stiffer construct and also confers greater stability over the time a fixator may be required. We commend this more informed design for the management of knee dislocations and vascular injuries.

Advances in Understanding and Managing Floating Knee Injuries: A Comprehensive Review.

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.

Evaluating the functional outcomes of tibia and ipsilateral femur fracture, which are floating knee injuries, in adults

Background: High velocity trauma leads to ipsilateral femur and tibia fractures. Despite being very uncommon, they have a significant morbidity rate. Combinations of diaphyseal, metaphyseal, and complicated intra-articular fractures may be present in this kind of injury. Objectives were to assess the functional success of adult patients with ipsilateral femur and tibia fractures treated with various methods. Methods: The 30 adult patients with floating knee injuries underwent surgical treatment as part of the prospective research at the department of orthopedics, govt. medical college, and affiliated group of institutions in Kota. A combination of implants, such as an intra-medullary nail, locking plates, screws, or external fixators, were used to treat both femur and tibia fractures. Results: Karlstrom-Olerud criteria were used for the final evaluation. In our study, five patients (16.6%) had excellent outcomes, ten (33.3%) had good results, seven (23.3%), had acceptable results, and eight (26.6%) had poor results. Conclusions: When the fracture is diaphysis and it is treated with intra-medullary nails for both the femur and the tibia, the results are excellent. In this way, the age of the patient, the kind of fracture, the methods of fracture fixation, and the functional result were all taken into account.

Functional evaluation of various modalities of management in floating knee injuries at a tertiary care centre in central India

Background: The injuries involving femur and tibia fractures due to high velocity are known as floating knee injuries. These fractures may involve the shaft, metaphysis or the articular surface. There are many complications associated with these injuries. This study evaluates the functional, clinical and radiological outcomes of floating knee injuries. Methods: A Prospective and interventional study was performed at MGMMC and MYH Hospital, Indore. We included 30 patients in our study. Femur fractures are managed by intramedullary nailing or distal femur plating. Tibia fractures are managed by Intramedullary nailing or tibia plating. Patient were called for regular follow up for a minimum of 6 months. Functional and clinical evaluation done by Karlstorm and olerud scoring system and radiological outcome by union on x rays were done. Results: Out of 30 patients 28 (93.33%) male and 2 (6.66%) female. According to Fraser classification, 17 (56.66%) type 1, 4 (13.33%) type 2A, 4 (13.33%) type2B, 5 (16.66%) type 2C injuries. A majority of the injuries occurred due to road traffic accidents involving right limb 21 (70%) more then left 9 (30%). Knee stiffness occurred in 8, infection in femur 3, infection in tibia 2, malunion of femur 2, limb length discrepancy in 2 patients. Outcome was excellent in 5 (16.66%), Good in 10 (33.33%), Acceptable in 9 (30%) and poor in 6 (20%). Conclusions: Fraser type 1 fracture has excellent results and Fraser type 2C has poor results. Closed fracture has better outcome compared to compound Fractures. A better functional outcome can be determined on the basis of implant choice based on Fraser Classification, level of injury, open or closed injury, simple or compound type of fracture.

Floating knee injuries - An Analysis of Outcome in Surgically Treated Patients in a Tertiary Care Institution

Background: Floating knee injuries are not uncommon and they occur due to high velocity trauma and are usually associated with other injuries. Early intervention in the form of internal fixation of both the femur and tibia usually results in better functional outcome. The present study was conducted with an aim to analyze the factors influencing the functional outcome of patients with ipsilateral femur and tibia fractures using Karlstrom and Olerud’s criteria.
 Methodology: 
 Patients aged more than 18 years of age of both sexes who were clinically and radiologically diagnosed with floating knee injuries were included as our study subjects. A total of 48 patients were taken as study sample. Classification of floating knee injuries was made according to Blake and McBryde’s classification. Fixation of femur was done before fixing the tibia. Anterograde and retrograde intramedullary nailing along with condylar plates were used for internal fixation of femur or tibia. 
 Results: 
 According to Blake and Mc Bryde fracture classification, 19 patients belong to type I, 22 patients had type II A fracture and 7 had type II B fracture. Head injury followed by chest and abdominal trauma are the most common associated injuries. The mean duration of tibial bone union was 22 weeks and for femur it was 26 weeks. Functional outcome assessment was made using Karlstorm and Olerud’s criteria. Majority of the patients with Type I fracture had excellent or good outcome, whereas patients with type IIA or IIB fractures had acceptable or good outcome. 
 Conclusion: 
 The present study revealed that early surgical intervention is the key factor in the management of floating knee injuries which when done the functional outcome was found to be good.

Outcome of Surgical Management of Ipsilateral Femur and Tibia Fracture: The Floating Knee Injury

IntroductionFloating knee injuries are one of the rare injuries of the lower limb involving fracture of ipsilateral femur and tibia. These injuries are often associated with other systemic injuries and have higher incidence of morbidity and mortality. Often times these fractures can pose difficulty in achieving union and might have residual stiffness around the knee. This study was carried out to assess the functional and radiological outcome of surgical management of floating knee injuries and the associated complications.MethodsA hospital based prospective study including 34 cases of surgically managed floating knee injuries over a period between January, 2017 and December, 2019 with the mean follow-up duration of 15 months was performed. The final outcome was evaluated on the basis of Karlstorm and Orelud criteria.ResultsFinal analysis was done based on the Karlstorm and Orelud criteria after the bony union was achieved. Based on the Karlstorm and Orelud criteria, 44.11% cases had excellent outcome, 29.41% cases had good outcome, 14.7% cases had a fair outcome and 11.76% cases had a poor outcome.ConclusionsFloating knee injuries are severe injuries often associated with polytrauma. Operative management in these complex injuries can yield favorable functional outcome with fewer complications.

Pediatric floating knee injuries: Clinical modifiers affecting sports and transfer outcomes

AimThis study assessed the functional outcome, and the clinical modifiers that influence them with the aim to assist the clinician plan a better management strategy in Paediatric Floating Knee (PFK) injuries. MethodsA quasi-prospective, single-center observational study was designed to determine the functional and radiological outcomes in children (</= 16 years), with minimum 1 year follow-up after treatment for PFK from 01–01–2014 to 01–08–2019. A retrospective audit was conducted, and a prospective patient/parent reported outcome score was determined with the Pediatric Outcome Data Collection Instrument (PODCI) questionnaire for ‘transfer and mobility’ and ‘sports and physical function’. ResultsOf 32 patients with PFK injury, twenty-five patients with a mean follow-up of 43 months (SD = 18) who completed the PODCI questionnaire were analysed. Fourteen (56%) children had open fractures (Lett's D or E types) with 6 open femur and 12 open tibia fractures. Majority underwent surgical fixation, 8 children required staged reconstruction and 11 children required soft tissue procedure in the ipsilateral limb. The mean time to union for femur and tibia fractures was 3.86 months (SD = 5.3) and 3.5 months (SD = 2.9), respectively with delayed union/non-unions in 3 femoral and 4 tibial fractures. The mean knee range of movement (RoM) was 102° (SD = 34.1) with limb shortening in 6 children, and overgrowth in 3 children. The mean normative PODCI (transfer) score was 35.6 (normal range: -74 to 52) and mean PODCI (sports) score was 37.6 (normal range: -33 to 56). Both the PODCI scores demonstrated strong inverse correlation with higher ISS(p < 0.01) and > 4 cm of bone loss (p < 0.01) but poor correlation with age at injury (p = 0.5), open fracture (p = 0.17), comminuted femoral and/or tibial fracture patterns (p > 0.05) and loss of soft tissue cover (p = 0.08). ConclusionsEarly recognition of clinical modifiers such as high ISS and bone loss > 4 cm warrants targeted limb reconstruction strategy and can help to prognosticate outcome.

The current issues and challenges in the management of floating knee injury: a retrospective study.

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. 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. 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. 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.

An overview of Floating Knee Injuries, Management Approach

Floating knee injuries are frequently associated with other serious injuries. Our study intends to evaluate the management and treatment of floating knee, as well as associated injuries, treatment techniques, treatment outcomes, and consequences. Electronic search performed on the most widely used biomedical databases, such as Medline. Floating knee with ipsilateral femoral and tibial fracture is a severe injury that is frequently associated with high-energy trauma and a variety of associated injuries that are frequently quite serious, as well as systemic and local effects. When planning treatment, it is critical to consider both the patient’s overall condition and the condition of the limbs. At times, amputation is a viable alternative. It is critical to evaluate injuries and complications before deciding on a surgical procedure. These injuries require the management of a multidisciplinary team with experience.

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

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.

Early Total Care Versus Damage Control Orthopedics in Floating Knee Injury: Analysis of Radiological and Functional Outcomes

IntroductionFloating knee injury (FKI) occurs as a result of a high-velocity impact. We assessed the radiological and functional outcomes of FKIs treated by various fixation methods, by damage control orthopedics (DCO) or early total care (ETC).Materials and methodsWe investigated 46 patients with FKI who were operated on between January 2013 and January 2018 at the RL Jalappa Hospital and Research Center, Kolar, India. Functional assessments were evaluated using Karlström and Olerud’s criteria (KOC). Based on their treatments, the patients were divided into the damage control orthopedics group (n = 21) and the ETC group (n = 25). Statistical analyses were used to obtain and compare summary data.ResultsThe data of 46 patients were collected. Fractures were classified using the modified Fraser’s classification. Five patients were not included in the final analysis because of death due to complications in the immediate postoperative period. In patients managed by DCO, after radiological union, the functional outcome was excellent in three cases, good in eight, fair in seven, and poor in two. The average time required for radiological union of the femur was 10.75 ± 1.482 months (P = 0.001); for tibia union, it was 10.25 ± 1.682 months (P = 0.011). The average range of knee flexion was 85°± 16.059° (P = 0.001), which was statistically significant. In patients managed by ETC, there were six cases with an excellent functional outcome, 13 with a good outcome, and two with a fair outcome. The average time required for radiological union of the femur was 9.29 ± 1.765 months (P = 0.006); for the tibia, it was 9.05 ± 1.161 months (P = 0.012). The average range of knee flexion was 100° ± 10.954° (P = 0.001), which was statistically significant. Fat embolism was noted in eight cases; four of these patients died due to multiorgan dysfunction. This was the major life-threatening complication in the early definitive fixation group. In the DCO group, only three cases had fat embolism, with one death due to multiorgan dysfunction. Early postoperative infection was a concern in the ETC group, evident in six cases.ConclusionThe classification system for FKI needs further research, which must include multiple parameters. Fracture classification and patient selection are crucial considerations in deciding the best treatment for a particular fracture.

A Study of Surgical Management of Floating Knee in Adults

&#x0D; &#x0D; Background: Floating knee injury is a term used to denote ipsilateral femoral and tibial metaphyseal injuries. But recent literature has however expanded this term to include most ipsilateral fractures of the femur and tibia. These areextremely heterogeneous groups of injuries. They usually occur due to very high energy trauma. These are relativelyuncommon injuries. These are always associated with high morbidity. Most of these injuries result in some permanent disability. There are no specific guidelines for the management. The implant choice needs to be determined depending onnature of fracture and soft tissue injuries.&#x0D; Material and Methods: This study is about the Functional Outcome of Surgical Managements of Floating Knee For this study 17 consecutive patients with ipsilateral femur and tibia fractures, All cases of ipsilateral tibia and femur fractures were included. Study duration of two years. Detailed history will be obtained using Performa with special attention to mechanism of injury. Evaluations including base line clinical features. Examination of other associated symptoms will bebased on history and physical examination. The plan of management for the given patient was made depending on the nature of fracture, location of fracture, associated soft tissue injuries. &#x0D; Conclusion: Patients who undergo primary nailing will have Excellent or Good results. The most important factors which determine the functional outcomes were the type of fractures (open or closed), nature of comminution including intraarticular extensions, timing of fixations and post operative infections. &#x0D; &#x0D; &#x0D; Keywords: Floating knee; primary nailing, intraarticular extension, comminution, metaphysic.

A Comparative study between Different Treatment Modalities of Floating Knee injury At Aswan University Hospital

Purpose: The study aimed at presenting a comparison between the modalities of treatment different of floating knee injury at Aswan University Hospital. Materials and Methods: This study is a prospective study including all of our 20 cases of floating knee injuries who were treated utilizing various treatment modalities at Aswan University Hospital between December 2018 and September 2019 with a follow-up period of 12 months Results: Based on the data analysis, nailing is a better modality in floating knee injury (especially with diaphyseal long bone). Moreover, plating is a good choice for distal fractures, the external fixator is considered a choice for limb saving(as in popliteal ischemia, open fractures(OG3), and compartment syndrome). Conclusion: Management of floating knee injury is critical as floating knee injury is not like other fractures. Floating knee injuries are serious injuries with a high rate of complications. Besides being caused by high-energy trauma with extensive skeletal and soft tissue damage, they are also associated with potentially life-threatening injuries of the head, chest, and abdomen. There are multiple controversies in surgical management starting from choosing suitable fixation for each patient according to variable conditions. Floating knee injury remains a challenging orthopedic problem in which regaining good knee function outcome is a major concern. Stable osteosynthesis to achieve rigid fixation and early mobilization should always be attempted.

An Analysis of Functional Outcome and Factors Influencing the Outcome in Floating Knee Injuries

Background: The objective of the study is to study the Functional outcome and factors influencing the outcome in Floating Knee Injuries. Methods: The study was conducted on patients in department of orthopaedics in S.C.B medical college &amp; hospital from December 2018 to December 2020 who are admitted with Floating Knee Injuries. Detailed history were obtained using study proforma a thorough musculoskeletal examination of both the knees will be done including neuro-vascular status and appropriate radiographs and if necessary CT scan will be done. Collection of Data of the patients were by brief history of injury, systemic and musculoskeletal examination, radiography of thigh with hip and knee and leg with knee and ankle in standard antero-posterior and Lateral View, follow up with radiological and clinical parameters. Clinical follow-up will be done at 2 weeks, 4 weeks, 8 weeks, 4 months, 6 months, 12 months intervals regarding union of fractured bone, assessment of range of motion of knee, pain on weight bearing. Results: In our study we found males are affected in 33 out of 34 patients (97%), right lower limb was involved in 28 out of 34 patients (82%),majority of the patients were of young age group between 16-40 years (60%),twenty five out of 34 patients (73%) had type I floating knee injury and 9out of 34 (27%) had type II floating knee injury, in most of the cases (70%) surgery was performed within 1 week of trauma. Knee stiffness was more common in older patients, communited fractures, Poor articular reduction. The communited fractures and poor articular reduction correlated significantly with malunion of fractures. Communited fractures were a statistically significant variable for Shortening. Open fractures, communited fractures and segmental fractures are statistically significant for non-union and delayed union. Conclusion: Floating knee injuries are due to high velocity motor vehicle accident. Men are affected more than women. The right-side injury is more frequent than the left side. 55% of patients in this study had an excellent and good functional outcome and 45% of patients had a fair or poor functional outcome. Local complications like wound infection seen in 17.1% of patients A communited fracture is the most common predictor affecting the functional outcomes like Knee stiffness, shortening, and time to union. The other predictors affecting the functional outcomes are poor articular reduction, open fractures, segmental fractures, older age and. The time to union of tibia is more than that of femur. Revision fixation for tibial fractures was more frequent than femoral fractures. Keywords: Floating knee, Knee injury, Functional outcome

Ipsilateral intertrochanter and femoral shaft fracture with a floating knee injury: A case report with management and review of literature

Isolated ipsilateral intertrochanteric fracture with femoral shaft fracture is a rare injury. Similarly, a floating knee injury (ipsilateral fractures of the femur and tibia) is relatively uncommon. We describe a case of 50 year old man with ipsilateral intertrochanteric fracture with the femoral shaft with an ipsilateral floating knee injury.

Bilateral Floating Knee Injuries in an Infant: A Case Report and Literature Review

Background: Floating knee injury is defined as ipsilateral fractures of the femur and tibia. It was mostly seen among young men and is generally caused by high-velocity trauma such as motor vehicle accidents and falling from height. Although isolated fractures of the femur or tibia are relatively common in children, floating knee injuries are rare in adolescents and even less frequent in younger children.&#x0D; Case Report: In this study, we reported a case of bilateral floating knee injuries of a 10-month old girl infant. Radiographic examinations revealed diaphyseal fracture of the left femur and proximal metaphyseal fracture of tibia compatible with floating knee injury type B according to the classification proposed by Letts et al. To the best of our knowledge, there was not any previous report of bilateral infantile floating knee injury in the literature.&#x0D; Conclusion: Pediatric floating knee injuries are relatively uncommon and extremely rare among infants. The preferred method of treatment is a surgical fixation for all fractures of all ages.

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

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.

Neglected infected floating knee injury: evaluation of closed reduction techniques.

Floating knee injury is uncommon yet challenging problem. The situation is more complicated by presence of infection, open comminuted fractures, and late presentation. The aim of this study was to evaluate the closed reduction techniques by circular external fixation in a single stage to treat patients having infected neglected floating knee injuries. This retrospective study included 19 patients with a mean age of 34.4years. The average duration from trauma to surgery was 51.1days. All patients had at least one infected open fracture. According to Fraser's classification, ten injuries were type I, one case was type IIa, four were type IIb, and four were type IIc. Patients were treated by closed reduction techniques using the Ilizarov principles. Orthoplastic procedures were done in four cases in the same surgical setting. Closed reduction and union were achieved in all cases with control of infection in 17 cases. The follow-up period averaged 41months. The mean knee flexion was 97.4°. The complications included 5° extension lag (two cases), malunion (three cases), refracture (two cases), and DVT (four cases). The bone results were excellent (12 cases), good (5 cases), and poor (2 cases). The functional results were excellent (two cases), good (seven cases), acceptable (seven cases), and poor (three cases). Closed reduction techniques using a circular frame provided a valid treatment option for infected neglected floating knee injuries in one stage without bone grafting. However, the high rate of complications and the diminished knee range of motion should be considered.