Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years

Rollo, Giuseppe; Falzarano, Gabriele; Ronga, Mario; Bisaccia, Michele; Grubor, Predrag; Erasmo, Rocco; Rocca, Guido; Tomé-Bermejo, Félix; Garcı́a-Dorado, David; Pichierri, Paolo; Rinonapoli, Giuseppe; Meccariello, Luigi

doi:10.1016/j.injury.2019.03.016

Cited by 41 publications

(34 citation statements)

References 27 publications

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“…Circular hexapod external fixation has great stability as external fixation around the knee joint [ 30 ]. The Ilizarov technique is an effective treatment method for complex limb injuries such as road traffic accidents, sports injuries, war trauma, and severe burns around the knee [ 5 – 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previously, there have been several reports of arthrodesis with the Ilizarov device after failed knee arthroplasty [ 1 – 4 ]. Additional studies with a larger number of patients with severe injuries such as road traffic accidents, sports injuries, and war trauma around the knee, are needed to confirm the use of circular external fixation as a feasible and effective treatment option [ 5 – 8 ]. The use of circular hexapod external fixation to treat severe knee dislocation due to burn scarring has not been reported previously in the English literature.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of circular hexapod external fixation with soft tissue reconstruction in treating severe knee dislocation due to burn scarring: a case report

Nozaka

Miyakoshi

Saito

et al. 2020

BMC Musculoskelet Disord

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Background Severe varus deformity and soft tissue injury caused by a burn around a complex knee dislocation is a rare injury. Soft tissue reconstruction and deformity correction with circular hexapod external fixation of the knee and hinged total knee arthroplasty (TKA) are challenging and can lead to major complications if not performed appropriately. We present a case in which a combination of soft tissue reconstruction, circular hexapod external fixation, and TKA was used treat severe knee dislocation due to burn scarring. Case presentation We report the case of a 58-year-old woman who presented for knee surgery with soft tissue reconstruction, deformity correction with circular hexapod external fixation, and hinged TKA for a severe complex deformity and soft tissue injury caused by a burn injury at 6 months of age. The left leg was shorter by 35 mm in terms of functional leg length discrepancy. She walked with a limp, with a marked varus deformity of the left knee during the stance phase of walking. After a 3-stage repair, the patient was able to walk without assistance, confirming improvement of mobility. Conclusion The treatment method was an effective use of a combination of soft tissue reconstruction, circular hexapod external fixation, and rehearsal surgery using a 3D printed bone model of the modular rotating hinge component of TKA, which was successfully used to treat a severe knee dislocation due to burn scarring. This staged surgery maintained the leg length and ultimately achieved a satisfactory alignment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness of circular hexapod external fixation with soft tissue reconstruction in treating severe knee dislocation due to burn scarring: a case report

Nozaka

Miyakoshi

Saito

et al. 2020

BMC Musculoskelet Disord

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“…oating knee injuries or most commonly in compound fractures in diaphyseal area [11][12][13]. Besides they are also commonly used always in limited economic reality [14].…”

Section: External Fixators Always Is Indicated In Open Fractures Thementioning

confidence: 99%

External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study

Sun

Zhou

et al. 2020

Preprint

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Background To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. Methods From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n=35), plate-screw (group B, n=30) and Kirschner wire(group C, n=26).The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. Results Four patients were lost to follow-up, and 87 patients were followed up for 5-35 months (average, 14.2 months). The operation time of group C(114.92±36.09min) was shorter than that of group A (142.27±47.05min) and group B(184.00±48.56min) (P<0.05). There was no difference in intraoperative blood loss among the three groups (P>0.05). The surgical and implants costs in group C (5.24±1.21, thousand dollars) is lower than that in group A (6.48±1.11, thousand dollars) and group B (9.37±2.16, thousand dollars) (P < 0.05).The fracture healing time of group C(5.67±1.42months) was significantly less than that of group A (6.90±1.33months) and group B(6.70±1.12months) (P<0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P<0.05). The wound infection and needle-tract infection did not differ among the three groups (P>0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P>0.05). Conclusion Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.Fund program: National Natural Science Foundation of China (11572222)

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“…The complication of floating knee (flail knee joint) occurs with a particularly high incidence. 1 In the later stages, Gustilo IIIC open comminuted fractures are prone to serious complications such as limb blood supply disorders, bone nonunion and infection, and amputation. [2][3][4] The rapid development of microsurgical techniques has provided better treatment options for Gustilo IIIC open fractures.…”

Section: Introductionmentioning

confidence: 99%

Masquelet technique combined with microsurgical technique for treatment of Gustilo IIIC open distal tibial fractures: a retrospective single-center cohort study

Wang

Tang

et al. 2020

J Int Med Res

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Objective: This study was performed to investigate the clinical effects of the Masquelet technique combined with a microsurgical technique for treatment of Gustilo IIIC open distal tibial fractures. Methods: Fifteen patients with a mean age of 39.3 AE 7.9 years (range, 21-43 years) with Gustilo IIIC open distal tibial fractures were treated by the Masquelet technique combined with a microsurgical technique from May 2013 to January 2017. The mean length of the bone defect was 6.9 AE 2.2 cm (range, 5.2-10.7 cm). The mean area of the wound defect was 129.3 AE 41.4 cm 2 (range, 83.7-180 cm 2 ). Complications and fracture healing were recorded. At the last follow-up, the functional outcome was measured using the Iowa ankle score. Results: All 15 patients achieved bone healing, and the median healing time was about 6.1 months (range, 5-8 months). No complications such as infection or nonunion occurred. At the last follow-up, the median Iowa ankle score was 82 (range, 68-88). The rate of an excellent and good Iowa ankle score was 86.6%. Conclusions: Application of the Masquelet technique combined with a microsurgical technique is an effective strategy for the treatment of Gustilo IIIC open distal tibial fractures.

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Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years

Cited by 41 publications

References 27 publications

Effectiveness of circular hexapod external fixation with soft tissue reconstruction in treating severe knee dislocation due to burn scarring: a case report

Effectiveness of circular hexapod external fixation with soft tissue reconstruction in treating severe knee dislocation due to burn scarring: a case report

External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study

Masquelet technique combined with microsurgical technique for treatment of Gustilo IIIC open distal tibial fractures: a retrospective single-center cohort study

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