BACKGROUND The phrase “floating knee is a flail knee joint,” referring to ipsilateral femoral and tibial fractures,was first used by Blake and Mc Bryde in 1975.This condition is often caused by a high-energy trauma ...BACKGROUND The phrase “floating knee is a flail knee joint,” referring to ipsilateral femoral and tibial fractures,was first used by Blake and Mc Bryde in 1975.This condition is often caused by a high-energy trauma with often extensive injury to the soft tissues,and is accompanied by life-threatening systemic complications,including head,chest or abdominal injuries and a high incidence of fat embolism.Floating knee is a severe and uncommon injury pattern.CASE SUMMARY A 27-year-old man sustained multiple injuries when the electric motorcycle he was riding was hit by a van.His injuries included traumatic hypovolemic shock,comminuted and open type II fractures of the left femoral shaft,fracture of the right femoral shaft,comminuted fracture of the bilateral tibial and fibular shaft,and multiple lacerations and abrasions on his forehead,lower lip,neck and limbs.The diagnosis was simultaneous bilateral floating knee complicated with soft tissue injuries.After emergency treatment and the exclusion of life-threating complications,open reduction and internal fixation were successfully performed using plates and screws in the bilateral femoral and tibial shafts.CONCLUSION Simultaneous bilateral floating knee is a rare and severe injury pattern.The treatment is challenging,and complications.We present a case report of a young adult who suffered from bilateral floating knees during road traffic accident.We also offer our treatment experience of this complex injury and review past literature.展开更多
The necessity and superiority of the surgical operation on children with floating knee injury and the fracture union and complications were investigated. Twenty-eight children with floating knee injury were subjected ...The necessity and superiority of the surgical operation on children with floating knee injury and the fracture union and complications were investigated. Twenty-eight children with floating knee injury were subjected to open reduction and internal fixation or external fixator. The patients were followed up for 18 months to 7 years. The curative effectiveness was scored by Karlstrom criteria. The results showed that no nonunion or deformity was found. The affected limb was 1.2 cm to 1.5 cm longer in 2 cases, 0.8 to 1.2 cm shorter in 3 cases than the contralateral. No severe dysfunction of knee joint occurred. The excellent-good rate was 92.8 % and the curative rate 71.4 respectively. So for children whose age is older than 5 years, it＇s a good way to treat the fractures of femur and tibia with open reduction and internal fixation or external fixator. The method can be advantageous for the nursing care, early function recovery, shortening of the hospital stay and avoidance of severe complications.展开更多
Lower limb fractures like floating knees are more common in urban areas of low-income countries. In addition, associated complex lesions are manifestations of polytrauma requiring correct and appropriate management. T...Lower limb fractures like floating knees are more common in urban areas of low-income countries. In addition, associated complex lesions are manifestations of polytrauma requiring correct and appropriate management. The treatment is mostly surgical. We present a 19-year-old patient with a floating knee due to ipsilateral femoral and tibial fractures and vascular compression treated with femoral and calcaneus traction followed by a long limb cast. For our patient, the management of the concomitant vascular compression threatening vital and functional prognosis was in focus aiming at avoiding a radical decision such as limb amputation. The non-operative treatment managed to restore the blood supply and save the limb. At the follow-up after 10 months the fractures were clinically healed and radiologically consolidated and the walking capacity was almost restored. Non-surgical treatment accompanied by daily monitoring can prevent the radical solution of amputation in the context of a floating knee with vascular compression. We want to draw attention to the weakness of the existing classifications because they do not take into account vascular lesions as well as the presence of open fractures to define the severity and evaluate the prognosis.展开更多
Purpose The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement(Fraser’s typeⅡ).This study aims to evaluate and compare the functional outcomes among different Frase...Purpose The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement(Fraser’s typeⅡ).This study aims to evaluate and compare the functional outcomes among different Fraser’s typeⅡfloating knee injuries after surgical management.Methods Twenty-seven patients with Fraser’s typeⅡfloating knee injuries(54 fractures)between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser’s floating knee classification into three different groups as typeⅡA(ipsilateral femoral shaft and tibial intra-articular involvement,n=11),typeⅡB(ipsilateral tibial shaft and femoral intra-articular involvement,n=9)and typeⅡC(both femoral and tibial intra-articular involvement,n=7).The differences among the groups were evaluated and compared.The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score(KOOS)which covers 5 subscales of pain,other symptoms,activities of daily living,sports and recreation,and quality of life.The result was also compared with standardized age-sex matched healthy population using paired samples t-test.Results All the patients were male,and the injury mechanism was solely roadside accident.The mean age was 29.8 years and injury severity score 17.9(comparable in all the three groups).Most injuries were observed on the right side(20 cases,74.1%).Based on paired samples t-test,the KOOS score of patients with Fraser’s typeⅡA was found to be better than that of typeⅡB and typeⅡC.Compared with the reference age-sex matched control group,patients with Fraser’s typeⅡB andⅡC fractures had significantly lower mean score in all KOOS subscales(all p<0.01).However,Fraser’s typeⅡA only revealed significant difference regarding the subscales of activities of daily living(p<0.0001),sports and recreation(p<0.0001),and quality of life(p<0.0001).Conclusion The results of this study show that patients with Fraser’s typeⅡA fractures had a better functional outcome as compared to those with typeⅡB andⅡC fractures.This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.展开更多
文摘BACKGROUND The phrase “floating knee is a flail knee joint,” referring to ipsilateral femoral and tibial fractures,was first used by Blake and Mc Bryde in 1975.This condition is often caused by a high-energy trauma with often extensive injury to the soft tissues,and is accompanied by life-threatening systemic complications,including head,chest or abdominal injuries and a high incidence of fat embolism.Floating knee is a severe and uncommon injury pattern.CASE SUMMARY A 27-year-old man sustained multiple injuries when the electric motorcycle he was riding was hit by a van.His injuries included traumatic hypovolemic shock,comminuted and open type II fractures of the left femoral shaft,fracture of the right femoral shaft,comminuted fracture of the bilateral tibial and fibular shaft,and multiple lacerations and abrasions on his forehead,lower lip,neck and limbs.The diagnosis was simultaneous bilateral floating knee complicated with soft tissue injuries.After emergency treatment and the exclusion of life-threating complications,open reduction and internal fixation were successfully performed using plates and screws in the bilateral femoral and tibial shafts.CONCLUSION Simultaneous bilateral floating knee is a rare and severe injury pattern.The treatment is challenging,and complications.We present a case report of a young adult who suffered from bilateral floating knees during road traffic accident.We also offer our treatment experience of this complex injury and review past literature.
文摘The necessity and superiority of the surgical operation on children with floating knee injury and the fracture union and complications were investigated. Twenty-eight children with floating knee injury were subjected to open reduction and internal fixation or external fixator. The patients were followed up for 18 months to 7 years. The curative effectiveness was scored by Karlstrom criteria. The results showed that no nonunion or deformity was found. The affected limb was 1.2 cm to 1.5 cm longer in 2 cases, 0.8 to 1.2 cm shorter in 3 cases than the contralateral. No severe dysfunction of knee joint occurred. The excellent-good rate was 92.8 % and the curative rate 71.4 respectively. So for children whose age is older than 5 years, it＇s a good way to treat the fractures of femur and tibia with open reduction and internal fixation or external fixator. The method can be advantageous for the nursing care, early function recovery, shortening of the hospital stay and avoidance of severe complications.
文摘Lower limb fractures like floating knees are more common in urban areas of low-income countries. In addition, associated complex lesions are manifestations of polytrauma requiring correct and appropriate management. The treatment is mostly surgical. We present a 19-year-old patient with a floating knee due to ipsilateral femoral and tibial fractures and vascular compression treated with femoral and calcaneus traction followed by a long limb cast. For our patient, the management of the concomitant vascular compression threatening vital and functional prognosis was in focus aiming at avoiding a radical decision such as limb amputation. The non-operative treatment managed to restore the blood supply and save the limb. At the follow-up after 10 months the fractures were clinically healed and radiologically consolidated and the walking capacity was almost restored. Non-surgical treatment accompanied by daily monitoring can prevent the radical solution of amputation in the context of a floating knee with vascular compression. We want to draw attention to the weakness of the existing classifications because they do not take into account vascular lesions as well as the presence of open fractures to define the severity and evaluate the prognosis.
文摘Purpose The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement(Fraser’s typeⅡ).This study aims to evaluate and compare the functional outcomes among different Fraser’s typeⅡfloating knee injuries after surgical management.Methods Twenty-seven patients with Fraser’s typeⅡfloating knee injuries(54 fractures)between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser’s floating knee classification into three different groups as typeⅡA(ipsilateral femoral shaft and tibial intra-articular involvement,n=11),typeⅡB(ipsilateral tibial shaft and femoral intra-articular involvement,n=9)and typeⅡC(both femoral and tibial intra-articular involvement,n=7).The differences among the groups were evaluated and compared.The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score(KOOS)which covers 5 subscales of pain,other symptoms,activities of daily living,sports and recreation,and quality of life.The result was also compared with standardized age-sex matched healthy population using paired samples t-test.Results All the patients were male,and the injury mechanism was solely roadside accident.The mean age was 29.8 years and injury severity score 17.9(comparable in all the three groups).Most injuries were observed on the right side(20 cases,74.1%).Based on paired samples t-test,the KOOS score of patients with Fraser’s typeⅡA was found to be better than that of typeⅡB and typeⅡC.Compared with the reference age-sex matched control group,patients with Fraser’s typeⅡB andⅡC fractures had significantly lower mean score in all KOOS subscales(all p<0.01).However,Fraser’s typeⅡA only revealed significant difference regarding the subscales of activities of daily living(p<0.0001),sports and recreation(p<0.0001),and quality of life(p<0.0001).Conclusion The results of this study show that patients with Fraser’s typeⅡA fractures had a better functional outcome as compared to those with typeⅡB andⅡC fractures.This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.
