EVALUATION OF RADIOLOGICAL AND FUNCTIONAL OUTCOME OF DIFFERENT OPERATIVE INTERVENTION IN FLOATING KNEE INJURY
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Keywords
floating knee, femur fracture, tibia fracture, nailing, plating
Abstract
Background: Floating knee, referred to as ipsilateral fractures of the femur and tibia, is usually associated with several complications and mortality. This study was designed to present our experience with management of this injury; mechanism of injury, complications of floating knee and functional outcome.
Materials and Methods: This study was performed in Department of Orthopaedics, MLB Medical College, Jhansi between August 2020 and September 2021. Patients having ipsilateral fracture Shaft of femur and tibia i.e., Fraser Type I and also ipsilateral fracture femur & tibia with extension into knee joint that is Fraser Type II A, type IIB, type IIC will be included in the study. Various surgical techniques were used in management of floating knee injury.
Results: All 40 patients suffered injury because of road traffic accident. The youngest patient was 15 years old and oldest was 50 years. Secondary procedure required by as 6 cases skin grafting, 7 cases flap and 8 cases bone grafting. Average hospital stay was 39 days. Most common complication was found as knee stiffness in 18 cases, non union in 9 cases and delayed union in 7 cases. Shortening of >3cm was found in 8 cases and local infection in 13 cases. By using Karlstrom and Olerud criteria the functional outcome was excellent in 18 45% cases, good in 22.50% cases, acceptable in 15.0% cases and poor in 17.5% cases.
Conclusion: The associated injuries and type of fracture (open, intra-articular, comminution) are prognostic factors in a floating knee. Properly and timely managed injuries can yield good outcomes with fewer complication rate.
References
2. McBryde A. Jr., Blake R. The Floating knee, Ipsilateral fractures of femur and tibia, J.B.J.S, 1974 Sept; Vol. 56(A), pp. 1309.
3. Omer G.E., Moll J.H., Bacon W.L., Combined fractures of femur & tibia in single extremity, J. Trauma, 1968; Vol. 8, pp.1026-1041.
4. Ratliff AHC, Fractures of the shafts of the femur and tibia in the same limb., J.B.J.S., 1965; Vol. 47(B), pp. 3,586.
5. Winston M.E. The results of conservative treatment of fractures femur and tibia in same limb, Surg. Gynae&Obstet, Vol. 134, pp.985-91.
6. Gilliquist J., Rieger A. Sjodhahl R., Bylund P, Multiple fractures in a single limb - A therapeutic problem, Acta. Chir. Scandinavica, 1973; Vol. 139 pp. 167-172.
7. Fraser R.D., Hunter G. A Ipsilateral fractures of the femur and tibia, J.Bone & Joint Surg, 1978; Vol. 142 (B), pp. 115-122.
8. Karlstrom G., Olerud S. Ipsilateral fractures of femur and tibia, J. Bone & Joint Surg, 1977; Vol. 9(A), pp. 240-3.
9. Abalo A, Randolph S, Ayouba G, Walla A, Dossim A. Floating knee: Epidemiology and results of treatment. Niger J Orthop Trauma 2011; 10:23-7.
10. A. Elmrini. A. Elibrahimi. O. Agoumi . F. Boutayeb. M. Mahfoud. A. Elbardouni. M. Elyaacoubi. Ipsilateral fractures of tibia and femur or floating knee. International Orthopaedics (SICOT) (2006) 30: 325– 328.
11. Bonnevialle JP, Kany J, Samaran P, Pascal JF, Rongiers M, Leininger P, Mansat M (1993) Fractures associées homolatérales diaphysaires fémorale et tibiale. Rev Chir Orthop 79:55–59
12. Alho A, Ekeland A, Stromsoe K, Folleras G, Thoresen BO (1990) Locked intramedullary nailing for displaced tibial shaft fractures. J Bone Joint Surg (Br) 72:805–809
13. Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M, Evidence-Based Orthopaedic Trauma Working Group. Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma. 2006 Jan;20(1):76–9.
14. Yue JJ, Churchill RS, Cooperman D, The floating knee in pediatric patient: Churchill R.S. Non-operative vs. Operative treatment Cooperman D., Clin Orthop, 2000; Vol. 376, pp. 124-136.
15. Gregory P, DiCicco J, Karpik K, DiPasquale T, Herscovici D, Sanders R. Ipsilateral Fractures of the Femur and Tibia: Treatment with Retrograde Femoral Nailing and Unreamed Tibial Nailing. J Orthop Trauma. 1996; 10(5):309.
16. Philipson J Philip, Georgekutty, Manesh Stephen and Ahamad Shaheel Sultan. Functional outcome of floating knee injuries after fixation: A follow up study. International Journal of Orthopaedics Sciences 2020; 6(2): 336-339
17. Anastopoulos G, Assimakopoulos A, Exarchou E, Pantazopoulos Th. Ipsilateral fractures of the femur and tibia. Injury. 1992; 23(7):439-41.
18. Veith RG, Winquist RA, Hansen JS. Ipsilateral fractures of the femur and tibia. A report of fifty-seven consecutive cases. J Bone Joint Surg Am. 1984; 66(7):991-1002.
19. Mahesh Suresh Kulkarni, Monappa Naik Aroor, Sandeep Vijayan, Saurabh Shetty, Sujit Kumar Tripathy, Sharath K Rao. Variables affecting functional outcome in floating knee injuries. Injury.2018. Aug;49(8):1594-1601.
20. Vidya Sagar, Nitin Kumar, Ashutosh Kumar, Santosh Kumar. Outcomes of Surgical Management of Floating Knee Injuries. International Journal of Contemporary Medical Research, 2020, Vol 7(7): G4-G7.
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Pankaj Kumar Verma
Junior Resident, Department of Orthopedic, MLB Medical College Jhansi UP India
Praveen Raj Saraogi
Lecturer, Department of Orthopedic, RDMC banda UP India
Raj kapoor
Assistant Professor, Department of Orthopedic, RDMC banda UP India
Manoj Verma
Associate Professor, Department of Orthopedic, RDMC banda UP India