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

Hegazy, Alaa M.

doi:10.4055/cios.2011.3.2.133

Cited by 32 publications

(33 citation statements)

References 23 publications

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“…Specificity of FK injury makes it difficult to interpret the score Karlström and Olerud [ 6 ], also it is incompletely adapted to assess this multilevel lower limb trauma [ 36 ]. However, this large series confirm the worst results when one of the fracture involve an articular surface as previously known [ 21 , 23 , 26 , 36 ]. Considering the functional outcome, an older age, a vascular lesion, a Fraser type II FK, an open fractures, the amount of fracture comminution, a central pivot lesion are contributing factors of poorer results.…”

Section: Discussionsupporting

confidence: 87%

“…The incidence of non-union is rather high (20%) in our study, compared with the rate of recent literature varying from 4% to 11% for the femur and from 3% to 30% for the tibia [ 21 - 27 , 29 , 30 ]. The predictive factors have been emphasized in the statistical analysis above.…”

Section: Discussioncontrasting

confidence: 61%

“…This study has significant limitations especially the multicentric character, with a quantitative uneven recruitment between the five different centers spread over time (2000-2006), the retrospective setting based on the clinical and radiological data, and an insufficient follow-up to assess joint degeneration over the time. Nevertheless this study is interesting by its large number of cases compared with the series of the recent literature not exceeding few dozen of cases [ 13 , 21 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Traumatic Floating Knee: A Review of a Multi-Centric Series of 172 Cases in Adult

Féron¹,

Bonnevialle²,

Piétu³

et al. 2015

TOORTHJ

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The traumatic floating knee in adults (FK) is a combined injury of the lower limb defined by ipsilateral fractures of the tibia and femur. The first publications emphasized the severity of injuries, the bad results after conservative treatment, the most severe functional outcome in case of articular fracture and the frequency of associated cruciate ligament injuries. The surgical management of FK has been highly modified according the improvement of the fracture fixation devices and the operative techniques. This retrospective multicentric observational study included 172 adults with a FK injury admitted in emergency in 5 different level I or II trauma centers. All the patients data were collected on an anonymized database. Results were evaluated by the overall clinical Karlström’s score at latest follow-up. Fracture union was assessed on X-rays when at least 3 out of 4 cortices were in continuity in two different radiological planes. A statistical analysis was performed by a logistic regression method. Despite some limitations, this study confirms the general and local severity of this high-energy trauma, mainly occurring in young people around the third decade. A special effort should lead to a better initial diagnosis of associated ligamentous injury: a tear of PCL can be suspected on a lateral-ray view and a testing of the knee should be systematically performed after fixation of the fracture under anesthesia. Secondary MRI assessment is sometimes difficult to interpret because of hardware artifacts. The timing of fracture fixation is discussed on a case by case basis. However, a first femoral fixation is recommended except in cases of tibia fracture with major soft tissue lesion or leg ischemia requiring the tibia fixation first. Also a tibia stabilized facilitates the reduction and fixation of a complex distal femur fracture. The dual nailing remains so far for us the best treatment in Fraser I FK. Further prospective studies are needed to validate treatment algorithms, best fixation techniques in order to decrease the rate of complication and improve the functional outcome of floating knee injuries.

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Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Traumatic Floating Knee: A Review of a Multi-Centric Series of 172 Cases in Adult

Féron¹,

Bonnevialle²,

Piétu³

et al. 2015

TOORTHJ

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“…Apesar de algumas publicações apontarem que a classificação de Blake & McBryde ter sido evidenciada como a mais reconhecida e mais utilizada, 14 a opinião dos autores é que a classificação de Fraser deve ser eleita em casos de joelho flutuante. Isso se deve ao fato de que além de ser mais reprodutível, conforme exposto nos resultados, diversos estudos apontam para a presença de fratura intra-articular como um dos principais fatores prognósticos, [15][16][17][18] e a classificação de Fraser oferece um maior detalhamento do traço intra-articular.…”

Section: Discussionunclassified

Avaliação da concordância interobservador das classificações de Fraser e Blake & McBryde para joelho flutuante

Neto¹,

Neto²,

Souza³

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Avaliar a concordância interobservador de duas classificações para joelho flutuante: Fraser e Blake & Mcbryde. Método Trinta e dois observadores, subdivididos de acordo com o grau de titulação (26 médicos residentes e seis médicos ortopedistas especialistas em trauma ortopédico) classificaram 15 fraturas de fêmur e tíbia ipsilaterais. A concordância interobservador foi avaliada pelo coeficiente Kappa. Resultado Ao avaliar a concordância entre os 9 R1, obteve-se índice Kappa para classificação de Fraser de 0,58 e para a classificação de Blake & McBryde de 0,46. Entre os 7 R2, obteve-se índice de 0,59 para a classificação de Fraser e 0,51 para a classificação de Blake & McBryde. Entre os 10 R3, o índice de concordância foi maior para as duas classificações: 0,72 para a classificação de Fraser e 0,71 para a de Blake & McBryde. Considerando os 3 grupos (R1, R2, R3) como um só grande grupo, calculou-se o índice Kappa geral, que teve como resultado 0,63 para a classificação de Fraser e 0,56 para a classificação de Blake & McBryde. No grupo dos traumato-ortopedistas especialistas em joelho, por sua vez, obteve-se uma concordância para a classificação de Blake e McBryde de 0,597 e para a de Fraser de 0,843. Conclusão Comparativamente, as duas classificações apresentaram grau de concordância fraco a moderado. A classificação de Fraser teve melhor concordância em ambos os grupos. A concordância foi maior quando se avaliou médicos ortopedistas especialistas em trauma ortopédico.

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“…Due to the scarcity of floating knees and their variability, the study of literature does not provide therapeutic guidelines especially for type II. [ 27 ] However, most authors recommend surgical treatment for both type I and for type II;[ 11 17 18 23 27 28 ] and in the most recent series, the treatment of floating knee type I made the maximum use double nailing[ 17 18 23 29 30 31 ] with two methods: Single versus double incision nailing technique. Comparing these two techniques, double nailing with single incision can make only one installation on ordinary radiolucent table with a significant time savings in both operative skin-to-skin time and the overall time including intervention and installation.…”

Section: Discussionmentioning

confidence: 99%

The intramedullary nailing using a single knee incision for treatment of extraarticular floating knee (nine cases)

Dahmani

Elrhazi

Elidrissi

et al. 2014

J Emerg Trauma Shock

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Context:Floating knee injuries are uncommon and complex injuries. Management of this injury has been variously described in the literature.Aims:We present the outcome of the intramedullary nailing using a single knee incision for treatment of extraarticular floating knee.Materials and Methods:We report a retrospective series of nine patients with extraarticular floating knee.Results:There were seven men and two women with an average age of 35 years. At least one of the fractures was open in three cases. The average Injury Severity Score was 17. According to Fraser's classification, 100% of the cases are type I. All our patients were treated by the intramedullary nailing using a single knee incision. The mean operating time was 146 min. The mean follow-up is 19 months. According to the Karlström criteria, the end results were excellent in two cases, good in four, acceptable in two, and poor in one. Bone union was achieved in eight cases with an average period of 93 days.Conclusions:The intramedullary nailing using a single knee incision has shown in this series better results.

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

Cited by 32 publications

References 23 publications

Traumatic Floating Knee: A Review of a Multi-Centric Series of 172 Cases in Adult

Traumatic Floating Knee: A Review of a Multi-Centric Series of 172 Cases in Adult

Avaliação da concordância interobservador das classificações de Fraser e Blake & McBryde para joelho flutuante

The intramedullary nailing using a single knee incision for treatment of extraarticular floating knee (nine cases)

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