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

Abstract

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.

Homolateral Hip Dislocation, Floating Hip Injury, and Floating Knee Injury: A Unique Presentation of a Rare Injury

“…X-ray film, computed tomography, and 3dimensional graphics revealed a sacrum wing fracture and pubic branches disruption on the right side and acetabulum comminuted fractures and hip joint posterior dislocation with some fracture pieces in the joint space on the left side.treatments,3,4 and severe functional outcomes may occur after articular fracture that are associated with ligament injuries. According to Feron et al,5 femoral fixation is recommended as a priority in most cases except in cases of tibial fracture with soft tissue problems requiring the tibial fixation first; dual nailing remains the best treatment for FKI.Lyddon and Hartmann 6 first reported FHI in 1971, and then Burd et al 7 summarized the complications and outcomes of 57 cases. After the reduction of femoral fractures, most acetabulum fractures were treated by open reduction and internal fixation with a Kocher-Langenbeck approach.…”

Complex pelvic ring injuries associated with floating knee in a poly-trauma patient

“…[ 13 , 14 ] Though the precise incidence of this complex injury is unknown, it is relatively uncommon. [ 2 , 15 ] Road traffic accident is the main cause of this trauma followed by falling injury. [ 16 ] With the force required to fracture 2 of the strongest bones is quiet immense, the injuries are mostly caused by high-energy trauma which may lead to extensive skeletal and soft tissue damage simultaneously.…”

“…Pelvic ring fracture and floating knee injuries occurring in the independent damage pattern are described in medical literature, [ 1 , 2 ] but there was no report of both injuries coexisting in the individual simultaneously. Pelvic fracture and floating knee injuries are usually caused by high-energy trauma which commonly resulted from crushing.…”

An Approach to Floating Knee Injury in Indian Population

“…Feron et al . 14 noted that the Karlstrom score was significantly dependent on the level of femoral fracture. They found that 66.2% of good or excellent results were in diaphyseal fractures while that percentage dropped to 12.5% in distal third femoral fractures.…”