Journal of Musculoskeletal Trauma

Comparison of Floating Knee according to Presence of Knee Joint Injury: Eau Sup Chung, Jong Hyuk Park, Hee Rack Choi, Joo Hong Lee, Kwang Bok Lee; J Korean Fract Soc 2012;25(4):277-282. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.277

Abstract PDF: PURPOSE
To compare the clinical outcomes of floating knee according to the presence of knee joint injury.
MATERIALS AND METHODS
Between March 2004 and March 2009, we investigated 36 patients, who underwent surgical treatment for floating knee injuries. We classified the floating knee into two groups as type I (12 cases) has no knee joint injury and type II (24 cases) has knee joint injury. We compared two groups about combined injury (orthopedics or other part), open fracture or not, neurovascular injury,union time, range of motion, and complication rate.
RESULTS
There is statistically no significant difference between two groups as type I (6 cases, 50%) and type II (13 cases, 54.2%) in orthopedic combined injury (p=0.813), and also same as type I (3 cases, 25%) and type II (12 cases, 50%) in combined injury on the other department (p=0.151), and in floating knee with open fracture as 4 type I (33%) and 12 type II (50%) of 16 cases (44%), and Gustilo-Anderson 3 type I, 4 type II, 1 IIIA, 4 IIIB, and 4 IIIC (p=0.423). There is statistically no significant difference between two groups in neurovascular injury as 1 type I (8.3%), and 3 type II (12.5%) (p=0.708). There is a statistically significant difference between two groups in the mean bone union time as 18.2+/-5.37 weeks (12~24 weeks) for type I and 24.95+/-9.85 weeks (16~33 weeks) for type II (p=0.045), and in the mean range of knee joint motion as 133+/-12.74 degree (120~150 degree) for type I and 105+/-19.00 degree (80~135 degree) for type II (p=0.012).
CONCLUSION
Floating knee with knee joint injury is severe itself and related with severe combined injuries, subsequent range of knee joint motion limitation, the delay of union time, and high complication rate. Therefore, we should take care in surgical treatment for this trauma entity.

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Management of Ipsilateral Femur and Tibia Fractures, with Retrograde and Antegrade Nailings from the Knee: Chang Wug Oh, Jong Keon Oh, Woo Kie Min, In Ho Jeon, Hyung Soo Ahn, Hee Soo Kyung, Poong Taek Kim, Jung Ho Noh; J Korean Fract Soc 2005;18(2):131-135. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.131

PURPOSE
To review the results in the management of ipsilateral femur and tibia fractures, using femoral and tibial intramedullary nailings with single incision on the knee.
MATERIALS AND METHODS
We treated 19 cases of ipsilateral femur and tibia fractures (floating knee), and the retrograde femoral nailing and antegrade tibial nailing were done with single incision on the knee. Except one patient of early death, 18 patients were included in this study. The mean age of index procedure was 34.1 years, and all of them had follow-up study for a mean of 2.4 years. The mean injury severity score was 18.8, and 12 patients had other fractures in the lower extremity.
RESULTS
Primary union was achieved in all, but one patient of femur and two of tibia. The average period for union was 27.6 weeks for femur and 24.5 weeks for tibia. One femoral nonunion occurred due to the metal failure after using short nail, and two tibial nonunion were caused by the bone loss with open tibial fractures. Most patients showed no limitation in knee motion. According to Karlstrom-Olerud criteria, functional results showed 14 excellent, 3 good and 1 acceptable. The protrusion of nail tip into the knee joint made the acceptable result with moderate limitation of knee motion, but it improved after the removal of nail.
CONCLUSION
CONCLUSION: Simultaneous retrograde femoral and antegrade tibial nailing with single incision on the knee, with an appropriate technique, can achieve the satisfactory result in the management of the ipsilateral femur and tibia fractures.

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Ipsilateral Femoral Segmental and Tibial Fractures: A Case Report
Oog Jin Sohn, Chul Hyun Park, Sang Keun Bae
Journal of the Korean Fracture Society.2009; 22(3): 193. CrossRef

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Bilateral Floating Knees Treated by 4 Intramedullary Nails: A Case Report: Phil Hyun Chung, Dong Ju Chae, Sang ho Moon, Ho Gyoon Bae; J Korean Soc Fract 1999;12(2):267-271. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.267

Abstract PDF: The treatment of simultaneous ipsilateral femoral and tibial fractures is a challenging therapeutic problem. Unfortunately, despites a number of reports on these fractures, guidelines for treatment have not been well established. Because the knee joint is isolated partially or completely, the term "floating knee"is used. But most of these injuries are ipsilateral and few bilateral cases were reported in the literatures. The authors reviewed a case of bilateral floating knee treated by 4 intramedullary nails without having any prolonged healing time or limited range of motion in both knee joint postoperatively.

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Surgical Treatment of Ipsilateral Fracture of the Femur and Tibia("Floating Knee"): Eu Sub Chung, Ki Sik Hong, Seung Soo Hwang; J Korean Soc Fract 1998;11(4):825-832. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.825

Abstract PDF: Ipsilateral fractures of the femur and tibia is also called "Floating knee", It is the term applied to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur and tibia. The principles of the treatment is focussed to the rigid fixation and early restoration of the knee function. Authors reviewed 24 patient in which were treated surgical management from January 1991 to June 1998. The results were as following : 1. The patient who had both diaphyseal fractures had better clinical result than metaphyseal fractures. And the metaphyseal fractures associated with intraarticular fractures were worse than other metaphyseal fractures. 2. At the last follow up, the excellent and good results were achieved in 71% of the patients treated with internal fixation of both fractures and 60% of the patient with external fixation of the tibia, but all of the patient with wxternal fixation of the femur were poor result by Karlstrom and Olerud criteria.

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The Treatment and Complications of Ipsilateral Fracture of the Femur and tibia: Kyu Min Kong, Ki Chan Ahn, Sung Seok Seo, Young Chang Kim, Jang Seok Choi, Young Goo Lee; J Korean Soc Fract 1997;10(3):556-561. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.556

Abstract PDF: Ipsilateral fracture of the femur and tibia is difficult to treat because it is often comminuted and combined with severe soft tissue injury. And The result of treatment is poor in most cases. The thirty-four cases were treated at Pusan Paik Hospital from March, 1992 to February, 1995. The result were as follows; 1. The bony union time was shorter in the intramedullary nailing than other methods. 2. There were less complications in the group of used intramedullary nailing than other methods. 3. The intramedullary nailing was relatively good treatment method for ipsilateral fracture of the femur and tibia.

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Treatment of the Ipsilateral fracture of Femur and Tibia in Children: Jong Seok Park, Yoon Sik Kim, Hee Kwon, Jun Min Song, Soo Kyun Rah, Chang Uk Choi; J Korean Soc Fract 1996;9(1):129-136. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.129

Abstract PDF: Sixteen cases of fracture of the femur and tibia on the same leg in children below 16 year age were treated in Soonchunyang Univ. Hospital during the period 1988-1993. We studied all of these patients, classified by LettsNew classification of pediatric floating knee, retrospectively with analysis of treatment and results. The results were as follows; 1. Among the 16 cases,14 cases were male(88%), and 10 cases(63%) were at their first decade and 6 cases(37%) were at second decades. 2. The main cause of injury was traffic accident;15 cases(94%). 3. The most common concomitant injury was fracture in other site;5 cases(31%). 4. Among the 9 cases of conservative treatment, limping and leg length inequality were occurred in 6 cases(61%), and malunion in 5 cases(56fo). 5. Among the 7 cases of operative treatment, limping was occurred in 1 cases(14%), leg length inequality was in 2 cases(29%), and malunion in 3 cases(43%). 6. Among the 10 cases at first decade, limping was occurred in the 6 cases(75%) out of 8 cases of conservative treatment, but it was not occurred in 2 cases of operative treatment. According to the results, we suggest that at least one fracture should be rigidly fixed in all cases.

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Treatment of Ipsilateral Fracture of the Femur and Tibia("Floating Knee"): Soo Bong Hahn, Gang Hee Koh; J Korean Soc Fract 1995;8(3):488-496. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.488

Abstract PDF

Concomitant ipsilateral femoral and tibial fractures present a challenging therapeutic problem. They are generally caused by high-energy trauma, primarily motor-vehicle accidents, and the local trauma to the soft tissue is often extensive. We retrospectively reviewed 48 cases of the ipsilateral fracture of femur and tibia from March 1983 to March 1993 and analyzed the clinical and functional results. The results were as follows. 1. The most common site of fracture was middle one-third and the most common type of the fracture was comminuted in both femur and tibia. 2. The most common associated injury was concomitant fracture and dislocation of other sites(28 cases) and fat embolism was developed in 4 cases and compartment syndrome was developed in 3 cases. 3. Satisfactory reults were achieved in 72% of the patients treated with internal fixation of both fracture, 63% of the patient with internal fixation for the femur and 43% of the patients managed conseuatively.

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Comparison of Floating Knee according to Presence of Knee Joint Injury
Eau-Sup Chung, Jong Hyuk Park, Hee Rack Choi, Joo Hong Lee, Kwang-Bok Lee
Journal of the Korean Fracture Society.2012; 25(4): 277. CrossRef

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