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.


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


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)

Functional Outcome of Total Knee Replacement in Osteoarthritic Knee with Fixed Flexion Deformity

Vol 43 | January 2022 | page: 14-19 | Debi Prasad Nanda

DOI: 10.13107/ojot.2022.v43i01.027

Authors: Debi Prasad Nanda [1]

[1] Department of Orthopedics, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.

Address of Correspondence

Dr. Debi Prasad Nanda,
Department of Orthopedics, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.


Osteoarthritis gradually leads to a flexion deformity which could be attributed to either soft tissue contractures or bony blocks due to proliferating abnormal osteophytes after which surgical intervention is advocated. The different surgical options which exist are high tibial osteotomy, proximal fibular osteotomy, and knee replacement which could be unicondylar or Total. Amongst all these Total Knee replacement (TKR) provides a way to overcome all afflictions of arthritis. A prospective study was conducted in the department of orthopaedics in S.C.B medical college & hospital from October 2018 to October 2020 in 30 Patients who presented with a flexion deformity of the knee due to osteoarthritis. The mean age of the patients was 55.8±6.25 years (range 44-69). The disease is more common in the geriatric age group patients with the highest proportion (36.67%) cases in the 56-60 years age group. The male to female ratio was almost 1:2. The left knee was found slightly more affected 16(53%) than the right knee 14 (47%). Most of the patients 18 (60%) were in KL Stage III Osteoarthritis which signifies the negligence on part of the patient in seeking early medical care. The mean knee range of motion in flexion was 86.6⁰ ± 10.5⁰ (range 68-110). Additional Varus deformity was seen in 10 (33.3%) cases. No cases of valgus deformity were found in our study. The difference between the means of pre and post-op FFD is 21.9(18.37-25.42, 95% CI). The difference between the means of pre and post-op scores is 41.3 (35.0-47.5, 95% CI). The difference between the means of pre and post-op scores is 43.19 (37.0-49.3, 95% CI). In an Indian scenario where the patient comes late with gross varus and fixed flexion deformity, Posterior Cruciate Sacrificing Total Knee Replacement will give greater mobility and stability, so it can be the preferred mode of management. This implies the universality of Total Knee Arthroplasty as the Gold standard in the treatment of Osteoarthrosis of knee cutting across demographic variation and socio-economic distributions.
Keywords: Total flexion deformity, Total knee replacement, Osteoarthritis, Functional outcome



1. Pal CP, Singh P, Chaturvedi S, Pruthi KK, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian J Orthop. 2016;50(5):518-522.
2. Gilbert, Alexa & Li, Chuan Silvia & Sancheti, Parag & Hanson et al. The Natural History of Knee Osteoarthritis: India-based Knee Osteoarthritis Evaluation (iKare): A Study Protocol. Journal of long-term effects of medical implants. 2013;23: 93-104.
3. Hwang YS, Moon KP, Kim KT, Kim JW, Park WS. Total Knee Arthroplasty for Severe Flexion Contracture in Rheumatoid Arthritis Knees. Knee Surg Relat Res.2016;28(4):325-329.
4. Crawford DC, Miller LE, Block JE. Conservative management of symptomatic knee osteoarthritis: a flawed strategy?. Orthop Rev (Pavia). 2013;5(1):e2. Published 2013 Feb 22.
5. Vaishya R, Pariyo GB, Agarwal AK, Vijay V. Non-operative management of osteoarthritis of the knee joint. J Clin Orthop Trauma. 2016;7(3):170-176.
6. G. M. Woolhead, J. L. Donovan, P. A. Dieppe, Outcomes of total knee replacement: a qualitative study, Rheumatology, Volume 44, Issue 8, August 2005,1032–1037
7. Sabatini L, Risitano S, Rissolio L, Bonani A, Atzori F, Massè A. Condylar constrained system in primary total knee replacement: our experience and literature review. Ann Transl Med. 2017;5(6):135.
8. Chethan VS, Tomichan MC. Functional outcome in total knee replacement. J. Evid. Based Med. Healthc. 2018; 5(35), 2550-2555.
9. Sachin NS,Praveen M,Rao MV,Manjunath J,Dinesh K : Clinical and functional outcome following total knee arthroplasty in primary osteoarthritis knees using PCL substituting prosthesis ; International Journal of Orthopaedics Sciences 2017; 3(2):795-800
10. Zheng H, Chen C. Body mass index and risk of knee osteoarthritis: systematic review and metaanalysis of prospective studies. BMJ Open 2015;5:e007568.
11. Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987;30(8):914-918.
12. Cheng K,Ridley D,Bird J,McLeod G: Patients with fixed flexion deformity after total knee arthroplasty do just as well as those without:ten-year prospective data; International Orthopaedics (SICOT) (2010) 34:663–667
13. Harato K, Nagura T, Matsumoto H, et al. Extension limitation in standing affects weight-bearing asymmetry after unilateral total knee arthroplasty. J Arthroplasty 2010;25:225–229.

How to Cite this Article: Nanda DP | Functional Out come of Total Knee Replacement in Osteoarthritic Knee with Fixed Flexion Deformity | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 14-19.

(Abstract Text HTML)      (Download PDF)

A Retrospective Analysis of Functional and Radiological Outcome of Different Modalities of Treatment of Fracture of Distal Radius

Vol 43 | January 2022 | page: 05-09 | Soumendra Kumar Majhi

DOI: 10.13107/ojot.2022.v43i01.025

Authors: Soumendra Kumar Majhi [1]

[1] Department of Orthopaedics, Sri Rama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India.

Address of Correspondence

Dr. Soumendra Kumar Majhi,
Department of Orthopaedics, Sri Rama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India.


Background: Fractures of the distal radius remain the most common fractures approximately one-sixth of all fractures treated in emergency departments. There are three main peaks of fracture distribution: the first peak is in children ages 5 to 14, the second is in males under age 50 and the third peak is in females over the age of 40 years. Risk factors are – decreased bone mineral density, female gender, ethnicity, heredity & early menopause have all been shown to be risk factors for this injury. The outcome of these fractures is not uniformly good regardless the treatment instituted. A thorough understanding of the anatomy & biomechanics of the wrist is a prerequisite when treating these lesions. There is a strict relationship between the quality of anatomical reconstruction & the long-term functional outcome. No single treatment is the solution for every type of fracture in every kind of patient. Based on the functional anatomy, we analyze the actual treatment possibilities & try to develop strategies in the choice of treatment for different fracture types in different patient groups.
Materials and Methods: 92 Patients with extra-articular distal radius fractures were studied retrospectively. 30 were treated with conservative management and 62 with surgical management. Out of 62 cases treated surgically, 11 were managed by Plate osteosynthesis, 27 with Ligamentotaxis with External fixator & 24 with K wire fixation using Kapandji method at Department of Orthopaedics, Sri Rama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, since July 2018 to November 2020.
Results: The association of individuals anatomical parameters with the functional results was measured by Chi-square test of association and Odds ratio with the criteria of Stewart et al. taken as base line for comparison. This study showed a significant association of dorsal angulation < 10° and loss of radial inclination of < 9° with functional results, P < 0.001 also with loss of radial height < 6 mm, P < 0.001 (0.005). On reviewing literature only few articles were found determining values of individual radiological parameters for better functional outcome specially Smilovic et al. (2003) and few of them noted which parameters affect the function most but not determining the values for them.
Conclusion: There was no significant difference in the functional outcome of conservative treatment in comparison to various surgical modalities namely plate osteosynthesis, ligamentotaxis and k wire reduction with Kapandji method in case of extra articular and partial articular fractures of distal radius. Therefore, we cannot generalize one treatment method for all fracture patterns and treatment should be individualized to a particular fracture.
Keywords: Distal radius fracture, Radiological outcome, Functional outcome


1. Canale & Beaty. Campbell’s Operative Orthopaedics. 13th edn. Vol III: Page 3441- 3453.
2. Bucholz, Robert W, Heckman, James D, Court-Brown, Charles M: Fractures of distal radius & ulna: Rockwood & Green’s Fractures in Adults, 6th edition: Chapter 26: Page 910-962.
3. Gray, Henry( 1825–1861). Anatomy of the human body, by Henry Gray. 40th edn. Section – 6 : chapter – 50 : Page 870 – 876.
4. Maruan Haddad, Guy Rubin, Michael Soudry & Nimrod Rozen. External Fixation for the treatment of intra-articular Fractures of the distal radius: short- term results. IMAJ. July 2010; VOL 12
5. David L Nelson. How to classify distal radial fractures – a report. eRADIUS International Distal Radius Fracture Study Group, IFSSH Bone & Joint Committee. Nov 2006.
6. Grahm T J. Surgical correction of mal-united distal radius. Jr. Academic Orthopaedic Surgery.1995; 5: 270-281.
7. Koji Fujii, Tatsuhiko Henmi, Yoshiji Kanematsu, Takuya Mishiro, Toshinori Sakai & Tomoya Terai. Fractures of the distal end of radius in elderly patients: A comparative study of anatomical & functional results. Journal of Orthopaedic Surgery 2002, 10(1): 9–15
8. Joy C Macdermid. The Patient-Rated Wrist Evaluation (PRWE) User Manual. School of Rehabilitation Science. December 2007
9. S. Nijs, P. L. O. Broos. Fractures of the Distal Radius : a Contemporary Approach. Acta chir belg, 2004; 104: 401-412.
10. Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986 May; (206):202-10.
11. Frankie Leung, Dokuz Eylul, Shew Ping Chow. Conservative treatment of intra- articular fractures of the distal radius — factors affecting functional outcome. Hand Surgery. December 2000; Volume 05: Issue 02.
12. Carrozzella J, Stern PJ. Treatment of comminuted distal radius fractures with pins & plaster. Hand Clinic. 1988 Aug; 4(3): 391-7.
13. Kongsholm-J, Olerud-C. Plaster cast versus external fixation for unstable intra- articular Colles’ fractures. Clin Orthop Relat Res. April 1989 ; 57-65AB.
14. Jakim I, Pieterse HS, Sweet MB. External fixation for intra-articular fractures of the distal radius. J Bone Joint Surge Br. 1991 Mar; 73(2): 302-6.
15. Fernandez DL, Geissler WB. Treatment of displaced articular fractures of the radius. Journal of Hand Surgery. 1991 May; 16(3):375-84.
16. Arora J, Kapoor H, Malik A, Bansal M. Closed reduction & plaster cast immobilization vs. external fixation in comminuted intra-articular fractures of distal radius. IJO. 2004 ; Vol 38 : Issue : 2 : Page : 113-117.
17. Bartosh-R-A., Saldana. Intra-articular fractures of the distal radius: a cadaveric study to determine if ligamentotaxis restores radio-palmar tilt. J-Hand-Surg- [Am]. 1990 Jan. 15(1). P 18-21.
18. Horesh Z, Volpin G, Hoerer D, Stein H. The surgical treatment of severe comminuted intra-articular fractures of the distal radius with the small AO external fixation device. A prospective three-and-one-half-yr follow-up study. Clin Orthop Relat Res. 1991 Feb; (263):147-53.
19. Helen HG Handoll, James S Huntley, Rajan Madhok. External xation versus conservative treatment for distal radial fractures in adults. Cochrane Database of Systematic Reviews 2007, Issue 3.
20. Clyburn-T-A. Dynamic external fixation for comminuted intra-articular fractures of the distal end of the radius. J-Bone-Joint-Surg-[Am]. 1987 Feb; 69(2): P 248-54.
21. Bassett-RL. Displaced intra-articular fractures of the distal radius. Clin-Orthop. 1987 Jan; (214): 148-52
22. Fitoussi F, Chow. S.P: The University of Hong Kong, Hong Kong, The Journal of Bone & Joint Surgery. 1997; 79:1303-12.
23. Charles S. Day, Atul F. Kamath, Eric Makhni, Jerome Jean-Gilles, David Zurakowski. “Sandwich” Plating for Intra-articular Distal Radius Fractures with Volar & Dorsal Metaphyseal Comminution. Hand. 2008 March; 3(1): 47–54.
24. Herdrich S, Bauer J, Pichl J, Hoffmann R. Management of complex intra- articular distal radius fractures with open reduction & internal fixation with double dorsal locking plates. Z Orthop Unfall. 2010 Jan;148(1):72-9.
25. M. Jakob, D. A. Rikli, P. Regazzoni. Fractures of the distal radius treated by internal fixation & early function – a prospective study of 73 consecutive patients. J Bone Joint Surg [Br] 2000; 82-B:340-4.
26. Karl M. Koenig, Garrett C. Davis, Margaret R. Grove, Anna N.A., Tosteson, ScD Kenneth J. Koval. Is Early Internal Fixation Preferred to Cast Treatment for Well-Reduced Unstable Distal Radial Fractures?. J Bone Joint Surg Am. 2009 Sep 01; 91(9):2086-2093.
27. Knirk-JL; Jupiter-JB Intra-articular fractures of the distal end of the radius in young adults. :J-Bone-Joint-Surg-Am; 68(5): 647-59: June 1986.
28. Harish Kapoor, Ashoo Agarwal, B.K Dhaon, Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation & open reduction with internal fixation. International Journal of care of injured. Mar 2000. Volume 31, Issue 2, pages 75 – 79.
29. Chin-En Chen, Rei-Jahn Juhn & Jih-Yang Ko. Treatment of Distal Radius Fractures with Percutaneous Pinning & Pin-in-plaster. Hand. 2008 Sep; 3(3): 245–250.
30. Melone. Open treatment for displaced articular fractures of the distal radius. Jr. Clin-Orthop. 1986 Jan; (202): P 103-11.
31. Szabo-R-M. Weber. Comminuted intra-articular fractures of the distal radius. Clin-Orthop. 1988 May; (230): P 39-48.
32. Rodríguez-Merch`n, Carlos E. Management of Comminuted Fractures of the Distal Radius in the Adult: Conservative or Surgical?. Clinical Orthopaedics & Related Research: August 1998 – Volume 353 – Issue – pp 53-62
33. Jupiter, Jesse B, Lipton, Howard. The Operative Treatment of Intra-articular Fractures of the Distal Radius. Clinical Orthopaedics & Related Research: July 1993 – Volume 292 – Issue
34. Handoll HH, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003: (3)
35. Toshiko Hirashima, Wook-Cheol Kim, Kouei Kawamoto, Takashi Yoshida, Toshikazu Kubo. Evaluating Bone Union of Distal Radius Fractures by Measuring Impedance Values. The Cutting Edge: January 2009 – Volume 32 · Issue 1.

How to Cite this Article: Majhi SK | A Retrospective Analysis of Functional and Radiological Outcome of Different Modalities of Treatment of Fracture of Distal Radius | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 05-09.

(Abstract Text HTML)      (Download PDF)