Clin Orthop Surg.  2011 Jun;3(2):133-139. 10.4055/cios.2011.3.2.133.

Surgical Management of Ipsilateral Fracture of the Femur and Tibia in Adults (the Floating Knee): Postoperative Clinical, Radiological, and Functional Outcomes

• Hegazy AM

• KMID: 1719310
• DOI: http://doi.org/10.4055/cios.2011.3.2.133

Abstract

BACKGROUND
This study evaluated the outcomes of surgical management of ipsilateral femoral and tibial fractures in adults.
METHODS
Fifteen patients (13 men, 2 women; mean age, 34.8 years; range, 18 to 65 years) were enrolled in this study. The fractures types were classified according to the classification by Fraser et al. as follows: type I (5), type IIa (3), IIb (4), IIc (3). Femur fractures were treated using locked intramedullary nails, plate-screws, or dynamic condylar screws, and tibia fractures were treated with an external fixator (in open fractures), or plate-screws, and locked intramedullary nailing. The mean follow-up duration was 2.2 years (range, 1.3 to 4 years).
RESULTS
The extent of bony union according to the Karlstrom criteria was as follows: excellent, 8; good, 4; acceptable, 2; poor, 1.
CONCLUSIONS
The associated injuries and type of fracture (open, intra-articular, comminution) are prognostic factors in a floating knee. The best management of the associated injuries for good final outcome involves intramedullary nailing of both the fractures and postoperative rehabilitation.

Keyword

Ipsilateral; Fracture; Femur; Tibia; Floating knee

MeSH Terms

Adolescent
Adult
Aged
Female
Femoral Fractures/radiography/*surgery
Follow-Up Studies
Fracture Fixation, Intramedullary/instrumentation/*methods
Humans
Male
Middle Aged
Multiple Trauma/radiography/*surgery
Orthopedic Fixation Devices
Prognosis
Tibial Fractures/radiography/*surgery
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 Case 4, type I floating knee with (A) an open fracture of the right tibia treated by external fixator and (B) a closed fracture of the right femur treated by intramedullary nail.

• 

  Fig. 2 Case 7, type I floating knee with closed fractures of the femur and tibia treated with intramedullary nails. (A) Femur fracture: (1) preoperatively, (2) immediately postoperatively, (3) 12 months postoperatively. (B) Tibia fracture: (1) preoperatively, (2) 12 months postoperatively.

• 

  Fig. 3 Case 9, type IIc floating knee with (A) closed fractures of the left femur and tibia. (B) The femoral fracture was treated with dynamic compression screw and the tibial fracture was treated with plating. Union occurred 12 months postoperatively.

• 

  Fig. 4 Case 15, type IIc floating knee with (A) closed fractures of the left femur and tibia. (B) The fractures were treated with plating and union occurred 12 months postoperatively.

Reference

1. Lundy DW, Johnson KD. "Floating knee" injuries: ipsilateral fractures of the femur and tibia. J Am Acad Orthop Surg. 2001. 9(4):238–245.

2. Jeong GK, Pettrone SK, Liporace FA, Meere PA. "Floating total knee": ipsilateral periprosthetic fractures of the distal femur and proximal tibia after total knee arthroplasty. J Arthroplasty. 2006. 21(1):138–140.

3. Hayes JT. Multiple fractures in the same extremity: some problems in their management. Surg Clin North Am. 1961. 41(5):1379–1388.

4. Omer GE Jr, Moll JH, Bacon WL. Combinded fractures of the femur and tibia in a single extremity: analytical study of cases at Brooke General Hospital from 1961-to1967. J Trauma. 1968. 8(6):1026–1041.

5. Bansal VP, Singhal V, Mam MK, Gill SS. The floating knee: 40 cases of ipsilateral fractures of the femur and the tibia. Int Orthop. 1984. 8(3):183–187.

6. Singh Chhina JP, Kapila R. Ipsilateral fractures of femur and tibia: a clinical study. Indian J Orthop. 1999. 33(3):159–161.

7. Fraser RD, Hunter GA, Waddell JP. Ipsilateral fracture of the femur and tibia. J Bone Joint Surg Br. 1978. 60(4):510–515.

8. Behr JT, Apel DM, Pinzur MS, Dobozi WR, Behr MJ. Flexible intramedullary nails for ipsilateral femoral and tibial fractures. J Trauma. 1987. 27(12):1354–1357.

9. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976. 58(4):453–458.

10. Karlstrom G, Olerud S. Ipsilateral fracture of the femur and tibia. J Bone Joint Surg Am. 1977. 59(2):240–243.

11. Adamson GJ, Wiss DA, Lowery GL, Peters CL. Type II floating knee: ipsilateral femoral and tibial fractures with intraarticular extension into the knee joint. J Orthop Trauma. 1992. 6(3):333–339.

12. Ratliff AH. Fractures of the shaft of the femur and tibia in the same limb. Proc R Soc Med. 1968. 61(9):906–908.

13. Ostrum RF. Treatment of floating knee injuries through a single percutaneous approach. Clin Orthop Relat Res. 2000. 375:43–50.

14. Kao FC, Tu YK, Hsu KY, Su JY, Yen CY, Chou MC. Floating knee injuries: a high complication rate. Orthopedics. 2010. 33(1):14.

15. Dwyer AJ, Paul R, Mam MK, Kumar A, Gosselin RA. Floating knee injuries: long-term results of four treatment methods. Int Orthop. 2005. 29(5):314–318.

16. Theodoratos G, Papanikolaou A, Apergis E, Maris J. Simultaneous ipsilateral diaphyseal fractures of the femur and tibia: treatment and complications. Injury. 2001. 32(4):313–315.

17. Oh CW, Oh JK, Min WK, et al. Management of ipsilateral femoral and tibial fractures. Int Orthop. 2005. 29(4):245–250.

18. Ríos JA, Ho-Fung V, Ramírez N, Hernández RA. Floating knee injuries treated with single-incision technique versus traditional antegrade femur fixation: a comparative study. Am J Orthop (Belle Mead NJ). 2004. 33(9):468–472.

19. Schiedts D, Mukisi M, Bouger D, Bastaraud H. Ipsilateral fractures of the femoral and tibial diaphyses. Rev Chir Orthop Reparatrice Appar Mot. 1996. 82(6):535–540.

20. Szalay MJ, Hosking OR, Annear P. Injury of knee ligament associated with ipsilateral femoral shaft fractures and with ipsilateral femoral and tibial shaft fractures. Injury. 1990. 21(6):398–400.

21. Paul GR, Sawka MW, Whitelaw GP. Fractures of the ipsilateral femur and tibia: emphasis on intra-articular and soft tissue injury. J Orthop Trauma. 1990. 4(3):309–314.

22. 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):309–316.

23. Yokoyama K, Tsukamoto T, Aoki S, et al. Evaluation of functional outcome of the floating knee injury using multivariate analysis. Arch Orthop Trauma Surg. 2002. 122(8):432–435.

24. Arslan H, Kapukaya A, Kesemenli CC, Necmioglu S, Subasi M, Coban V. The floating knee in adults: twenty-four cases of ipsilateral fractures of the femur and the tibia. Acta Orthop Traumatol Turc. 2003. 37(2):107–112.

25. Hee HT, Wong HP, Low YP, Myers L. Predictors of outcome of floating knee injuries in adults: 89 patients followed for 2-12 years. Acta Orthop Scand. 2001. 72(4):385–394.

26. Hung SH, Lu YM, Huang HT, et al. Surgical treatment of type II floating knee: comparisons of the results of type IIA and type IIB floating knee. Knee Surg Sports Traumatol Arthrosc. 2007. 15(5):578–586.

27. Rethnam U, Yesupalan RS, Nair R. Impact of associated injuries in the floating knee: a retrospective study. BMC Musculoskelet Disord. 2009. 10:7.