Ipsilateral Femoral Fracture Research Articles

Acetabular "Fleck" Sign: Outcomes of Surgical Repair.

Traumatic, posterior hip dislocations in the pediatric population are typically managed by closed reduction to achieve a concentric hip joint. The presence of an acetabular "fleck" sign, despite concentric reduction, has been shown to signify significant hip pathology. The purpose of this study was to evaluate the outcomes of open labral repair through a surgical hip dislocation (SHD) in a consecutive series of patients with an acetabular "fleck" sign associated with a traumatic hip dislocation/subluxation. A retrospective review of patients between 2008 and 2022 who presented to a single, level 1 pediatric trauma center with a traumatic posterior hip dislocation/subluxation was performed. Patients were included if they had an acetabular "fleck" sign on advanced imaging and underwent open labral repair through SHD. Medical records were reviewed for sex, age, laterality, mechanism of injury (MOI), and associated orthopaedic injuries. The modified Harris hip score (mHHS) was utilized as the primary clinical outcomes measure. Patients were assessed for the presence of heterotopic ossification (HO) and complications, including implant issues, infection, avascular necrosis (AVN), and post-traumatic dysplasia. Twenty-nine patients (23 male, average age: 13.0±2.7 y; range: 5.2 to 17.3) were identified. Eighteen injuries were sports related, 9 caused by motor vehicle accidents, and 1 pedestrian struck. All patients were found to have an acetabular "fleck" sign on CT (26 patients) or MRI (5 patients). Associated injuries included: femoral head fracture (n=6), pelvic ring injury (n=3), ipsilateral femur fracture (n=2), and ipsilateral PCL avulsion (n=1). At the latest follow-up (2.2±1.4y), all patients had returned to preinjury activity/sport. Three patients developed asymptomatic, grade 1 HO in the greater trochanter region. There was no incidence of AVN. One patient developed post-traumatic acetabular dysplasia due to early triradiate closure. mHHS scores showed excellent outcomes (n=21, 94.9±7.4, range: 81 to 100.1). The acetabular "fleck" sign indicates a consistent pattern of osteochondral avulsion of the posterior/superior labrum. Restoring native hip anatomy and stability is likely to improve outcomes. SHD with open labral repair in these patients produces excellent clinical outcomes, with no reported cases of AVN. Level IV-therapeutic.

Management of floating hip injury: a review of the literature.

The aim of this study was to provide a comprehensive overview of floating hip injury and attempt to provide a management algorithm. PubMed was searched using the terms 'Floating hip' or 'acetabular fracture' and 'Ipsilateral femoral fracture' or 'pelvic fracture' and 'Ipsilateral femoral fracture'. One author performed a preliminary review of the abstracts and references of the retrieved articles. The mean injury severe score reported was higher than 20. Chest and abdominal injuries, as well as fractures at other sites, were the most common associated injuries. Despite the high disability rate, surgery remained the preferred option for managing these injuries. The surgical timing varied from a few hours to several days and was subjected to the principles of damage control orthopedics. Although, in most cases, fixation of femoral fractures took precedence over pelvic or acetabular fractures, there was still a need to consider the impact of damage control orthopedics, associated injuries, and surgeon's considerations and preferences. Posttraumatic arthritis, neurological deficits, heterotopic ossification, femoral head necrosis, femoral nonunion, and limb inequality were common complications of the floating hip injury. The severity of such injuries often exceeds that of an isolated injury and often requires specialized multidisciplinary treatment. In the management of these complex cases, the complexity and severity of the injury should be fully assessed, and an appropriate surgical plan should be developed to perform definitive surgery as early as possible, with attention to prevention of complications during the perioperative period.

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.

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.

Bony hip reconstruction for displaced hips in patients with cerebral palsy: Is postoperative immobilization indicated?

Decisions for postoperative immobilization after bony hip reconstructive surgery in cerebral palsy are controversial in current practice. The aim of this study was to check if choosing not to use any kind of postoperative immobilization is a safe practice. A retrospective cohort study was conducted in a pediatric orthopedic tertiary referral center. The study included 148 patients (228 hips) with cerebral palsy, who had bony hip surgery. Medical records were reviewed for incidence of complications, methods of pain control, and length of hospital stay. Three radiographic measures (neck-shaft angle, Reimers migration index, and acetabular index) were performed on preoperative and postoperative X-rays. X-rays were also checked for mechanical failure of implant, recurrent dislocation/subluxation, and fractures in the first 6 months postoperatively. In total, 94 (64%) were male and 54 (36%) were female. Seventy-seven (52%) were Gross Motor Function Classification System V, mean age at surgery was 8.6 years (2.5-18.4 years). Length of hospital stay was 6.25 days (SD 4.64 days). Medical complications that may have prolonged hospital stay occurred in 41 patients (27.7%). Radiological measurements showed significant improvement postoperatively (p = 0.001). Seven patients (4.7%) had another surgery in first 6 months (three for recurrent dislocation/subluxation, three for implant failure, and one for ipsilateral femur fracture). Avoiding postoperative immobilization following bony hip surgery in cerebral palsy is a safe practice and associated with reduced rate of medical and mechanical problems compared to the current literature. This approach should be utilized with optimal pain and tone management.

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.

"Floating Hip": Epidemiology and Quality of Care.

The "floating hip" is a rare and complex fracture involving the pelvis and the ipsilateral femur and is therefore difficult to treat. Data and studies on this topic are still scarce. The optimal strategy for surgical treatment and thus the resulting quality of treatment are still being debated; a femur-first strategy is often the preferred treatment. Retrospectively, patients with a pelvic fracture treated at the Level I Trauma Centre of the University of Tübingen between 2003 and 2017 were identified. Patients with an additional ipsilateral femur fracture were identified in this collective. We compared the quality of treatment of pelvic fractures between floating and non-floating hip injuries. Proximal femur fractures were more common with pelvic ring fractures (n=16) than with acetabular fractures (n=1). Floating hip injuries occur more frequently in younger polytraumatised male patients. Pelvic fractures in floating hip injuries are operated more frequently (62.8% vs. 39.1%; p=0.003) and the clinical course is significantly longer (27.8±19.3 vs. 19.9±23.1 days; p<0.001). However, the quality of treatment of pelvic fracture, exemplified by morbidity (18.6% vs. 14.6%; p=0.610) and mortality (7.0% vs. 2.6%; p=0.108), shows no differences. Injury severity and complexity of pelvic fracture is significantly higher in floating hip injuries, but without affecting the resulting quality of treatment. A "femur first" treatment strategy is preferable. Algorithms for emergency treatment and definitive care are proposed in a flowchart.

Traumatic posterior dislocation of hip with ipsilateral fracture of shaft of the femur: external maneuvers reduction and osteosynthesis by screw plate about a case and review of literature at Tambacounda regional hospital in Senegal

&lt;p&gt;Traumatic hip dislocation associated with an ipsilateral femoral fracture is a rare injury. It occurs in a high-energy traumatic context. The classic mechanism consists of a fall with landing on the hip, which initially dislocates and the femur fracture occurs secondarily by adduction of the proximal fragment. The diagnosis is difficult in front of the fracture whose signs mask the vicious attitude of the dislocation. We reported the case of a passenger of a motorcycle who collided with a parked car. He was ejected from the motorcycle and landed on his right hip. We performed X-rays of hip and lower limb at his admission which revealed a dislocation of hip in its high posterior variety and a medio-diaphyseal fracture of femur on same side. Reduction of dislocation by external maneuvers was made and osteosynthesis of femur with screwed plate performed 48 h later. After 16 months of care, functional and radiological results sufficient.&lt;/p&gt;

Intramedullary nailing of concurrent ipsilateral fractures of the tibia and femur: primary synchronous nailing versus staged osteosynthesis with temporizing external fixation.

The optimal timing to definitive osteosynthesis in the polytraumatized patient remains an unanswered question. Early total care, damage control orthopaedics, and early appropriate care have been described to manage the fractures in these patients, but there is a paucity of literature specific to ipsilateral tibial and femoral fractures. We sought the perioperative outcomes of primary simultaneous intramedullary nailing (IMN) versus temporizing external fixation (EF) of both fractures. A chart review of all patients who sustained fractures of the ipsilateral femur and tibia that were definitively treated with (IMN) from January 2010 to December 2020 was performed. Patients who underwent initial EF and those that were primarily treated with IMNs were examined. IMNs and EF were the initial treatment in 23 and 16 patients, respectively. The mean (range) injury severity score (ISS) was 23.3 (33) in the EF group vs. 18.5 (34) in the IMN group, (p = 0.0686). The EF group had a higher total transfused units of packed red blood cells 7.4 vs. 2.8, the mean initial operative time was 236 vs. 282.6 (min), (p = 0.7399), a longer mean total operative time 601.78 vs. 236 (min), and longer mean length of stay 15.6 vs. 11 (days), (p < 0.5). Rates of complications were not significantly different between groups. Primary IMN is as safe as provisional EF in the adequately resuscitated patient with ipsilateral femoral and tibial fractures. This implies the fixation of both fractures into a single surgery without increasing perioperative complications, and decreasing total hospital stay in patients with sufficient preoperative resuscitation.

Subsequent ipsi- and contralateral femoral fractures after intramedullary nailing of a trochanteric or subtrochanteric fracture: a cohort study on 2012 patients

BackgroundThe literature is inconclusive as to whether an intramedullary nail changes the distribution of a subsequent ipsi- or contralateral fracture of the femur. We have compared the incidence, localisation, and fracture pattern of subsequent femoral fractures after intramedullary nailing of trochanteric or subtrochanteric fractures in patients without previous implants in either femur at the time of surgery.MethodsRetrospective analysis was performed of a two-centre cohort of 2012 patients treated with a short or long intramedullary nail for the management of trochanteric or subtrochanteric fracture between January 2005 and December 2018. Subsequent presentations with ipsi- and contralateral femoral fractures were documented. Only patients with no previous femoral surgery performed, other than the index nailing were followed. Odds ratios (ORs) for subsequent femoral fracture were calculated using robust variance estimates in logistic regression.ResultsThe mean age of the cohort was 82.4 years and 72.1% were female. The total number of patients presenting with subsequent femoral fractures was 299 (14.9%). The number of patients presenting with subsequent ipsilateral and contralateral femoral fractures was 51 (2.5%) and 248 (12.3%) respectively (OR 5.0; CI 3.7–6.9). Twenty-six (8.7%) of all subsequent femoral fractures occured in the ipsilateral shaft, 14 (4.7%) in the ipsilateral metaphyseal area, one (0.33%) in the contralateral shaft, and three (1.0%) in the contralateral metaphysis (OR 10; CI 3.6–29).ConclusionAn intramedullary nail significantly changes the fracture pattern in the event of a second low-energy trauma, reducing the risk of subsequent proximal ipsilateral femoral fractures and increasing the risk of subsequent ipsilateral femoral fractures in the shaft and distal metaphyseal area compared with the native contralateral femur.

Posterior hip fracture-dislocation associated with posterior wall fracture of the acetabulum and ipsilateral comminuted trochanteric fracture of the femur: A case report.

Introduction and importanceTraumatic posterior dislocation of the hip is often associated with fractures of the femoral head and posterior wall of the acetabulum. However, hip fracture-dislocation that includes the posterior wall of the acetabulum and the ipsilateral femoral trochanter is rare. There is no consensus on the bone that should be operated on first, the operative position, and the choice of implant for femoral fixation.Case presentationA 67-year-old man was brought to our emergency department after a 2-m fall. He was diagnosed with a hip fracture-dislocation associated with posterior wall acetabular fracture and ipsilateral femoral trochanteric fracture. Surgical reconstruction was performed with intramedullary nail (IMN) fixation of the femoral trochanteric lesion, followed by anatomically rigid acetabular fixation in the lateral decubitus position. At the 5-year follow-up after the injury, the patient showed good objective and subjective clinical outcomes.Clinical discussionFixing the femur first could allow an easier reduction and traction. The lateral decubitus position was useful, because fixation of the femur and the acetabulum could be performed without changing the position. When fixing the femoral trochanteric lesion, attention was paid to reduce the anteromedial cortex of the proximal fragment extramedullarly to the distal fragment to prevent complications such as cutout and implant breakage.ConclusionAnatomically rigid fixation of the posterior wall of the acetabulum secondary to IMN fixation of the femur, with anteromedial cortical support in the lateral decubitus position, could achieve good objective and subjective clinical outcomes.

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.

Anterior Cruciate Ligament (ACL) Reconstruction and Extra-Articular Tenodesis in a Contralateral Above-Knee Amputee Following Complex Trauma: A Case Report

We report the outcome following arthroscopic ACL reconstruction combined with a Modified LeMaire procedure in a patient who underwent multiple surgeries following an open ipsilateral femoral fracture and an above knee amputation of the contralateral limb at the time of initial trauma. This case highlights the importance of achieving ligamental stability in the contra-lateral limb in aiding proper rehabilitation following amputation and the potential pitfalls of retrograde femoral nailing.

613 The Floating Hip: A Distinct Injury Pattern? A Descriptive Study and Case-Control Analysis

Abstract Aim A “Floating Hip” injury describes a simultaneous ipsilateral fracture of the femur and pelvis. We performed a descriptive study of the injury patterns, management, and outcomes of floating hip patients, and compared these patients to those with similar pelvic fractures without femoral involvement. Method This was a retrospective case-series review with secondary case-control analysis. Medical records of patients presenting with a floating hip injury to our tertiary orthopaedics department between 2015 and 2020 were reviewed. The control group comprised of patients with pelvic fractures but without associated femoral fractures, matched by age, sex, pelvic fracture classification, and mechanism of injury. Results 46 Floating Hip cases were identified (34 males), of average age 39 (15-86) years. 20 had acetabular fractures, 21 had pelvic ring fractures and 5 had both fractures, concomitant with ipsilateral femoral fractures. The most common site of femoral fracture was mid-shaft (21.7%), followed by distal (19.6%). 69.6% of P/A fractures were managed surgically, with ORIF (43%) the most common option. 4 (12.50%) patients suffered complications, including 2 infections and 1 DVT. Compared to controls, Floating Hip patients were more likely to require surgical management (67.6% vs 47.8%, p = 0.03), and had higher rates of surgical complications (12.5% vs 4.6%), though not statistically significant (p = 0.3). Conclusions Our study describes the patterns, management, and outcomes of Floating Hip injuries, and observes differences in the management and complications compared to similar pelvic fractures without femoral involvement. These findings suggest Floating Hip cases may warrant consideration as a distinct injury pattern.

Concomitant ipsilateral acetabular and femoral fractures – an appraisal of outcomes and complications in 34 patients

Concomitant ipsilateral femoral and acetabular fractures are complex injuries which result from high-velocity trauma. Surgical treatment is the accepted management of such injuries. The objectives of this study were to evaluate the outcomes and study the complications in patients treated for concomitant ipsilateral acetabular and femoral fractures (type 'B' floating hip injuries). This retrospective study was conducted at a tertiary care teaching hospital on patients operated for type B floating hip injuries, who had completed a minimum of one-year follow-up after the surgery and whose complete records were available. Those with floating hip injuries with pelvic fractures were excluded. All patients were operated on the femoral side first, followed by the acetabular side. 34 patients were included ; most of them were young males. A road traffic accident was the most common mode, with a dashboard injury being the most common mechanism of injury. No association between the type of acetabular and femoral fractures was found. The clinical (measured with Harris hip score) and radiological (Matta's method) outcomes at the latest follow-up were excellent or good in >60% cases and had a significant association with the quality of reduction on the post-operative radiographs. Complications were seen in 12 out of the 34 patients. Type B floating hips injuries can be managed well with acceptable short-term results by following a femur first strategy. However, patients must be informed of the possible complications and the probabilities of poorer outcomes when compared to isolated acetabular or femoral fractures.

Late-onset pseudoaneurysms of lower limb arteries following late complications of orthopaedic constructs - Two cases and review of literature.

Introduction & importanceDamage to the adventitial layer of an artery leads to pseudoaneurysm formation. Pseudoaneurysms caused by complications of orthopaedic constructs are rare.Case presentation & clinical discussionCase report 01. A 27-year-old male presented with acute bleeding from an external fixator pin site. He had defaulted follow-up due to covid pandemic and presented with malunited distal tibia fracture and loosened Schanz pins. CT angiogram revealed a pseudoaneurysm of the peroneal artery over the loosened pin site. The patient underwent exploration and ligation of the peroneal artery.Case report 02. 86-year-old female presented with a gradually enlarging lump on her left anteromedial thigh for three months duration. She underwent open reduction and internal fixation of ipsilateral femur fracture 17 months back. She was found to have a pseudoaneurysm of the superficial femoral artery caused by exposed screws following bony erosion. Exploration and repair of “neck” the pseudoaneurysm was performed and the recovery was uneventful.ConclusionPseudoaneurysms are rare but carry devastating complications following various orthopaedic procedures. The common cause for the formation of pseudoaneurysms is trauma during surgery. But loosened Schanz screws and screws are also can be the cause. Early identification of a pseudoaneurysm and proper intervention will reduce morbidities.

Operative Fixation Versus Cast Immobilization: Tibial Shaft Fractures in Adolescents.

Tibial shaft fractures are common injuries in the adolescent age group. Potential complications from the injury or treatment include infection, implant migration, neurovascular injury, compartment syndrome, malunion, or nonunion. Published literature was reviewed to identify studies which describe the management options, complications, and outcome of tibial shaft fractures in adolescents. Acceptable alignment parameters for tibial shaft fractures have been defined. Operative indications include open fractures and other severe soft tissue injuries, vascular injury, compartment syndrome, ipsilateral femoral fractures, and polytrauma. Relative indications for operative treatment are patient/family preference or morbid obesity. Closed reduction and cast immobilization necessitates radiographic observation for loss of reduction over the first 3 weeks. Cast change/wedging or conversion to operative management may be required in 25% to 40%. Flexible nailing provides relative fracture stability while avoiding the proximal tibial physis, but the fracture will still benefit from postoperative immobilization. Rigid nailing provides greater fracture stability and allows early weight bearing but violates the proximal tibial physis. Plate and screw osteosynthesis provide stable anatomic reduction, but there are concerns with delayed union and wound complications related to the dissection. External fixation is an excellent strategy for tibia fractures associated with complex wounds but also requires observation for loss of reduction. The majority of adolescent tibia shaft fractures can be successfully managed with closed reduction and cast immobilization. Unstable fractures that have failed cast treatment should be treated operatively. Flexible intramedullary nailing, rigid intramedullary nailing, plate and screw osteosynthesis, and external fixation are acceptable treatment options that may be considered for an individual patient depending upon the clinical scenario.

Challenges and outcomes in the treatment of floating knees. A case series of ipsilateral femur and tibia fractures around the knee.

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. 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. We identified 13 men and 4 women, aged between 16 and 52. Mean follow-up period was 16.49months. 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. 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.

Double fractures of the femur: a review of 16 patients.

Double ipsilateral femoral fractures account for 1-9% of femoral fractures. There is no clear advantage between single or double implant osteosynthesis. We present a series of patients with double ipsilateral femoral fractures, to address the challenges in treatment, namely the implants for osteosynthesis and complications of treatment. We retrospectively studied 16 patients (7 men, 9 women; mean age, 51years) treated from January 2015 to December 2018. Motor vehicle accidents were the leading cause of injury. Types of fractures were pertrochanteric and shaft (6), pertrochanteric and distal (2), double shaft (3), neck and shaft (2), neck and distal (1), shaft and distal (1), and triple fracture including a pertrochanteric, shaft and distal (1). In five patients, two different implants were used (plate and screws, cannulated hip screws, femoral nail), whereas in 11 patients a long femoral nail was used. Fourteen patients experienced union at a mean of 3months (2-6months). Two patients experienced nonunion: both had plate and screws osteosynthesis. One patient died 15days after admission from polytrauma and another patient experienced central venous catheter thrombosis and pneumonia. Surgical complications (2 patients) included a thigh skin necrosis, and external fixator pin tract infection/infected non-union. Weight-bearing was delayed in all patients; full weight-bearing was allowed in 11 patients at 4months postoperatively, and in four patients at 5months. Due to the rarity and the difficulty of standardization of double ipsilateral femoral fractures, there is variable information on the optimal osteosynthesis of the fractures and the outcome of the patients. It seems that closed reduction and long hip nailing is the treatment of choice, with few complications.