FLOATING KNEE. SURGICAL TREATMENT OF THE IPSILATERAL FRACTURES OF THE FEMUR AND TIBIA

Abstract

Aim: We present our experience of the treatment of the ipsilateral fractures of the femur and tibia. The so called “floating knee” is such a fracture caused by a high energy injury.

Method: During the last five years we admitted 19 patients with ipsilateral fractures of the femur and tibia. There were 18 men and one woman. Seven of them had a late treatment, after their discharge from th I.C.U. (Intensive Care Unit.).

We classified our patients in three groups.

In the first group there were 9 closed fractures of the femoral and the tibial shafts. The treatment composed of a tibial nailing combined with a retroverted femoral one.

Three out of six patients of the second group had a joint fracture of the femur combined with a closed fracture of the tibia. In the rest of them an exactly reversed condition existed. They were all treated with internal fixation of the femur combined with an external fixation of the tibia. In thee out of four patients of the third group there was an open fracture of the shaft of the femur. They were all treated with intramedulary nailing of both femur and tibia. The fourth one had an open fracture of the tibia and had external fixation of both femur and tibia.

Results: Six patients developed a delayed union and finally healed: one patient developed a pseudarthrosis that was healed after a second osteosynthesis and bone grafting: two patients had a shorter leg of 1–1.5 cm and another one had a50 varus knee. There were no postoperative infections or amputations one femoral nail failed because of breakage.

Conclusion: We consider that the intramedullary nailing of the femur and the tibia is mostly indicated for the floating knee in cases with no soft tissue damage or pacticipation of the joint itself. Our results were very satisfactory in all cases we applied this method.