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. 2022 Feb;32(2):325-331.
doi: 10.1007/s00590-021-02981-7. Epub 2021 Apr 21.

Challenges and outcomes in the treatment of floating knees. A case series of ipsilateral femur and tibia fractures around the knee

Carlos-Alberto Piedra-Calle  1 , Yaiza García-Sánchez  2 , Jordi Teixidor-Serra  3 , Jordi Tomás-Hernández  3 , Jordi Selga-Marsá  3 , Juan-Antonio Porcel-Vázquez  3 , Vicente Molero-García  3 , José Vicente Andrés-Peiró  4
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Challenges and outcomes in the treatment of floating knees. A case series of ipsilateral femur and tibia fractures around the knee

Carlos-Alberto Piedra-Calle et al. Eur J Orthop Surg Traumatol. 2022 Feb.

Abstract

Background: Ipsilateral femur and tibia fractures around the knee (floating knee) are rare injuries that threaten both limb viability and patient life. A correct surgical strategy is essential to reduce complications and sequelae. The aim of this study was to evaluate characteristics and results of treatment in patients with a floating knee treated at a single trauma center.

Material and methods: This is a retrospective and non-consecutive case series of 18 floating knees occurred in 17 patients. All patients were operated in a single third-level public and university hospital from December 2010 to December 2018. Data on demographics, injuries, treatment and follow-up were collected. A general health questionnaire (SF-12) and a knee functional questionnaire (KOOS-PS) were used to display results.

Results: We identified 13 men and 4 women, aged between 16 and 52. Mean follow-up period was 16.49 months. High-energy trauma following a traffic collision was the most frequent mechanism. Mean Injury Severity Score (ISS) was 39.05, and a damage control strategy was used in 15 (83.33%) injuries. Extra-articular fractures (Fraser I) largely predominated, resulting in double intramedullary nailing in 72.22% of cases. Eleven injuries (61.11%) presented with an open fracture. Complications appeared in 6 (33.33%) injuries, being 3 infections. Mean score for the SF-12 was 35.59 for the physical dimension and 50.44 for mental dimension. Mean score for the KOOS-PS was 43.64.

Conclusion: Floating knee injuries usually occur in polytrauma contexts. Visceral involvement and exposed fractures are common, so the most appropriate strategy is usually a staged treatment. Complications and sequelae are frequent.

Keywords: Femur fracture; Floating knee; Polytrauma; Tibia fracture.

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