Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 2;14(6):e25615.
doi: 10.7759/cureus.25615. eCollection 2022 Jun.

Early Total Care Versus Damage Control Orthopedics in Floating Knee Injury: Analysis of Radiological and Functional Outcomes

Prabhu Ethiraj  1 , Ajay S Shringeri  1 , Arun Prasad P  1 , Arun H Shanthappa  1 , Vishnudharan Nagarajan  1
Affiliations

Early Total Care Versus Damage Control Orthopedics in Floating Knee Injury: Analysis of Radiological and Functional Outcomes

Prabhu Ethiraj et al. Cureus. .

Abstract

Introduction Floating knee injury (FKI) occurs as a result of a high-velocity impact. We assessed the radiological and functional outcomes of FKIs treated by various fixation methods, by damage control orthopedics (DCO) or early total care (ETC). Materials and methods We investigated 46 patients with FKI who were operated on between January 2013 and January 2018 at the RL Jalappa Hospital and Research Center, Kolar, India. Functional assessments were evaluated using Karlström and Olerud's criteria (KOC). Based on their treatments, the patients were divided into the damage control orthopedics group (n = 21) and the ETC group (n = 25). Statistical analyses were used to obtain and compare summary data. Results The data of 46 patients were collected. Fractures were classified using the modified Fraser's classification. Five patients were not included in the final analysis because of death due to complications in the immediate postoperative period. In patients managed by DCO, after radiological union, the functional outcome was excellent in three cases, good in eight, fair in seven, and poor in two. The average time required for radiological union of the femur was 10.75 ± 1.482 months (P = 0.001); for tibia union, it was 10.25 ± 1.682 months (P = 0.011). The average range of knee flexion was 85°± 16.059° (P = 0.001), which was statistically significant. In patients managed by ETC, there were six cases with an excellent functional outcome, 13 with a good outcome, and two with a fair outcome. The average time required for radiological union of the femur was 9.29 ± 1.765 months (P = 0.006); for the tibia, it was 9.05 ± 1.161 months (P = 0.012). The average range of knee flexion was 100° ± 10.954° (P = 0.001), which was statistically significant. Fat embolism was noted in eight cases; four of these patients died due to multiorgan dysfunction. This was the major life-threatening complication in the early definitive fixation group. In the DCO group, only three cases had fat embolism, with one death due to multiorgan dysfunction. Early postoperative infection was a concern in the ETC group, evident in six cases. Conclusion The classification system for FKI needs further research, which must include multiple parameters. Fracture classification and patient selection are crucial considerations in deciding the best treatment for a particular fracture.

Keywords: damage control surgery; early total care; floating knee; fraser classification; high-energy trauma.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Time for union of femur fracture
ETC, early total care; DCO, damage control orthopedics; TFU, time for union
Figure 2
Figure 2. Time for union of tibia fracture
ETC, early total care; DCO, damage control orthopedics; TFU, time for union
Figure 3
Figure 3. Knee flexion
ETC, early total care; DCO, damage control orthopedics
Figure 4
Figure 4. Karlström and Olerud’s outcomes for DCO and ETC
ETC, early total care; DCO, damage control orthopedics
See this image and copyright information in PMC

References

    1. The floating knee: ipsilateral fractures of the tibia and femur. Blake R, McBryde A Jr. https://pubmed.ncbi.nlm.nih.gov/807974/ South Med J. 1975;68:13–16. - PubMed
    1. Floating knee injuries: results of treatment and outcomes. Nouraei MH, Hosseini A, Zarezadeh A, Zahiri M. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908531/pdf/JRMS-18-1087.pdf. J Res Med Sci. 2013;18:1087–1091. - PMC - PubMed
    1. Floating knee injuries: postoperative complications and outcome. Shahzad K, Ahmad Khan RD, Yasin A. https://pubmed.ncbi.nlm.nih.gov/26878519/ J Pak Med Assoc. 2015;65:0–201. - PubMed
    1. Ipsilateral fracture of the femur and tibia. Fraser RD, Hunter GA, Waddell JP. J Bone Joint Surg Br. 1978;60-B:510–515. - PubMed
    1. Floating knee: a modified Fraser's classification and the results of a series of 28 cases. Ran T, Hua X, Zhenyu Z, Yue L, Youhua W, Yi C, Fan L. Injury. 2013;44:1033–1042. - PubMed

LinkOut - more resources