Posts

An Analysis of Functional Outcome and Factors Influencing the Outcome in Floating Knee Injuries

Vol 43 | January 2022 | page: 20-22 | Ram Gopal Panigrahi

DOI: 10.13107/ojot.2022.v43i01.028


Authors: Ram Gopal Panigrahi [1]

[1] Department of Orthopaedic Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India.

Address of Correspondence

Dr. Ram Gopal Panigrahi,
Department of Orthopaedic Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India.
E-mail: ramgopalpanigrahi@gmail.com


Abstract


Background: The objective of the study is to study the Functional outcome and factors influencing the outcome in Floating Knee Injuries.
Methods: The study was conducted on patients in department of orthopaedics in S.C.B medical college & hospital from December 2018 to December 2020 who are admitted with Floating Knee Injuries. Detailed history were obtained using study proforma a thorough musculoskeletal examination of both the knees will be done including neuro-vascular status and appropriate radiographs and if necessary CT scan will be done. Collection of Data of the patients were by brief history of injury, systemic and musculoskeletal examination, radiography of thigh with hip and knee and leg with knee and ankle in standard antero-posterior and Lateral View, follow up with radiological and clinical parameters. Clinical follow-up will be done at 2 weeks, 4 weeks, 8 weeks, 4 months, 6 months, 12 months intervals regarding union of fractured bone, assessment of range of motion of knee, pain on weight bearing.
Results: In our study we found males are affected in 33 out of 34 patients (97%), right lower limb was involved in 28 out of 34 patients (82%),majority of the patients were of young age group between 16-40 years (60%),twenty five out of 34 patients (73%) had type I floating knee injury and 9out of 34 (27%) had type II floating knee injury, in most of the cases (70%) surgery was performed within 1 week of trauma. Knee stiffness was more common in older patients, communited fractures, Poor articular reduction. The communited fractures and poor articular reduction correlated significantly with malunion of fractures. Communited fractures were a statistically significant variable for Shortening. Open fractures, communited fractures and segmental fractures are statistically significant for non-union and delayed union.
Conclusion: Floating knee injuries are due to high velocity motor vehicle accident. Men are affected more than women. The right-side injury is more frequent than the left side. 55% of patients in this study had an excellent and good functional outcome and 45% of patients had a fair or poor functional outcome. Local complications like wound infection seen in 17.1% of patients A communited fracture is the most common predictor affecting the functional outcomes like Knee stiffness, shortening, and time to union. The other predictors affecting the functional outcomes are poor articular reduction, open fractures, segmental fractures, older age and. The time to union of tibia is more than that of femur. Revision fixation for tibial fractures was more frequent than femoral fractures.
Keywords: Floating knee, Knee injury, Functional outcome


References


1. Rethnam V, Study of epidemiology, prognostic indicators and outcome following surgical management of floating knee. Journal of Trauma Management and Outcomes, 2007; Vol I (1), pp. 2; PMID: 1827- 1992.
2. Hung SH, Surgical treatment of Type II floating Knee : Comparisons of the results of type IIA and type II B floating knee; Official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc], 2007 May; Vol.15(5), PP. 578-86; PMID : 17203298.
3. Dwyer AJ, Paul R, Floating Knee injuries ; Long term results of four treatment methods; International Orthopedics; 2005 Oct; Vo. 29(5), pp. 314-8; PMID : 16132984.
4. RIOS JA, Floating knee injuries treated with single incision technique versus traditional anterograde femur fixation. American Journal of Orthopedics; 2004 Sep; Vol. 33 (9), pp. 468-72; PMID : 1509113
5. Adanson GJ, Wiss DA, Lowery GL, Peters CL, Type II floating knee: Ipsilateral femoral and tibial fractures with intra-articular extension into knee joint; [J.Orthop.Trauma]; 1992; Vol. 6 (3), pp. 333-9.
6. Anastopopulous G, Assimakolopous A, Exarchou E, Ipsilateral fractures of the femur and tibia; 1992; Vol. 23(7); pp. 439-1.
7. Anil Agarwal Floating injuries: review of the literature and proposal for a universal classification; Acta Orthop Beig; 2004 Dec.
8. Bansal F. Singhal V, The floating knee. 40 cases of Ipsilateral fractures of the femur and tibia Mam M.K.; Int. Orthopedics; 1984; Vol. 8(3), pp183-7.
9. Behr Jr., Apel D.M. Flexible intramedullary nails for lpsilateral fractures of the femur and Pinzur M.S. tibia, J. Trauma, 1987; Vol. 27, pp.1354-57.
10. Fraser R.D., Hunter G.A Ipsilateral fractures of the femur and tibia, J.Bone & Joint Surg, 1978; Vol. 142 (B), pp. 115-122.
11. Gregory P, Dicicco J, Karpik K. Sanders R. Ipsilateral fractures of femur and tibia treated with retrograde femoral nailing & unreamed tibial nailing, J. Orthop. Trauma, 1996; Vol. 10, pp.309-16.
12. Gustilo R.B., Anderson J.T. Prevention of infection in treatment of fractures study of 1025 open fractures, J.Bone & Joint Surg, 1976; Vol. 58(A), pp. 453.
13. Guohui Liu, Shuhua Yang, Jingyuan Du. Treatment of floating knee injury in children, J Huazhong Univ. Sci. Technology MED Sci, 2006 Jan.
14. Campbell‟s operative orthopedics, 13th edition, Vol.2. Page 1674.
15. Karlstrom G., Olerud S. Ipsilateral fractures of femur and tibia, J. Bone & Joint Surg, 1977; Vol. 9(A), pp. 240-3.
16. Leach R.E. Treatment of ipsilateral fractures of femur and tibia, J.B.J.S., 1973; Vol. 55(A), pp. 868.
17. Lett E, Vincent the `Floating Knee’ in children, J.B.J.S.68′(B), 1986; pp. 442-6.
18. McAndrew M.P., Pontarelli W., The long term follow up of ipsilateral femoral & tibial diaphyseal fractures, Clin. Orthop, 1988; Vol. 232, pp. 190-96.
19. 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.
20. Michael AIMS Fracture Mechanics, J.B.J.S, 1961; Vol. 43(B), pp.152-60.
21. 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.
22. Schatzker Symposium on trauma to leg & its sequellae, Am.Acad of Orthop Surgeons, 1979 April.
23. Tay B.K., Tong G.O. Ipsilateral fractures of femur and tibia [Annual of Academy of Medicine Singapore, 1982; Vol. 11(2), pp. 139-41.
24.Muñoz Vives J, Bel JC, Capel Agundez A, Chana Rodríguez F, Palomo Traver J, Schultz-Larsen M, Tosounidis T. The floating knee: a review on ipsilateral femoral and tibial fractures. EFORT Open Rev. 2016 Nov;1(11):375-382. [PMC free article] [PubMed]
25. Anari JB, Neuwirth AL, Horn BD, Baldwin KD. Ipsilateral femur and tibia fractures in pediatric patients: A systematic review. World J Orthop. 2017 Aug 18;8(8):638-643. [PMC free article] [PubMed]
26. Othman Y, Hassini L, Fekih A, Aloui I, Abid A. Uncommon Floating Knee in a Teenager: A Case Report of Ipsilateral Physeal Fractures in Distal Femur and Proximal Tibia. J Orthop Case Rep. 2017 May-Jun;7(3):80-83. [PMC free article] [PubMed]
27. Carta S, Riva A, Fortina M, Colasanti GB, Meccariello L. The Challenges of the Femoral Bone Loss in the Management of the Floating Knee IIB According Fraser: A Case Report. J Orthop Case Rep. 2018 Jan-Feb;8(1):3-7. [PMC free article] [PubMed]


How to Cite this Article: Panigrahi RG | An Analysis of Functional Outcome and Factors Influencing the Outcome in Floating Knee Injuries | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 20-22.

 


(Abstract Text HTML)      (Download PDF)