Floating Knee Injuries: A High Complication Rate

Abstract

Floating knee injuries are usually associated with complications and mortality, regardless of the treatment regimen. Orthopedic surgeons typically recommend various treatment regimens, especially aggressive and early stabilization of both femoral and tibial fractures. Some authors have reported that the complication and mortality rates remain high regardless of the treatment regimen used. The purpose of this retrospective study was to review the long-term results of treatments for floating knee injuries performed at our institution, and also to calculate the distribution of fracture types within patient age groups and the association with complications related to floating knee injury. We retrospectively reviewed medical records and radiographs of 419 floating knee injuries treated for postoperative complications from November 1987 to April 2003. Of the 419 patients with floating knee injuries, 104 (24.8%) developed complications. The result showed that the complication rate was associated with fracture type (open fracture [32.2%; P<.001], Fraser type IIc [36.8%; P<.001], tibial plateau [28.6%; P=.037], and distal tibia [28.6%; P=.035]). This study revealed that the complication rate associated with floating knee injuries remained high, regardless of the treatment regimen used. Surgeons should focus on reducing complications while treating floating knee injuries.

Surgical Management of Ipsilateral Fracture of the Femur and Tibia in Adults (the Floating Knee): Postoperative Clinical, Radiological, and Functional Outcomes

“…Kao et al14) summarized the indications of surgical treatment and concluded that patients with closed fractures or open type I or II fractures were treated according to the fracture site. Femoral fractures around the cervicotrochanteric area were fixed under traction with dynamic hip screws, dynamic compression screws, or cannulated screws on a fracture table.…”

The floating knee: a review on ipsilateral femoral and tibial fractures

“…Kao et al in fact did not comment on vascular insult in their report on 419 patients. 39 Fraser et al reported an incidence of 7% (16 of 222 patients). 3 …”

“…39 High rates of complications have been described. 40 In such injuries it is difficult to achieve good functional results due to important soft-tissue injuries and associated injuries, often resulting in life-threatening trauma of the head, chest, and abdomen or amputation of the limb.…”

“…Complications related to floating knee injuries include infection, excessive blood loss, fat embolism, malunion, delayed or nonunion, knee stiffness, prolonged hospitalisation and inability to bear weight. 39 …”

“…15,39-41 With multivariate analysis, some series reported that a significant contributing factor affecting the final outcome of floating knee injuries was intra-articular involvement of the knee joint. 15,39-41 Among the variables, Fraser type determines the final result and knee involvement and is considered the most significant contributing factor to the final outcome. 15,40 In some series, poorer results are found when one or both fractures are intra-articular than when both are diaphyseal.…”