To determine the functional outcome of floating knee injury a retrospective study was undertaken at 3 level 1 trauma centers.

Methods: Between 1998 and 2004, 96 consecutive patients were identified with at least 2 years follow up. The average age of the cohort is 31 years (15–74) with 76 males. The average ISS was 17.3 (9–57), 31.3% of the patients were multiply injured (ISS > 18). According Fraser’s classification, 78 patients presented a type I lesion. At least one of the fracture was open in 77% of cases.

Results: The preferred fixation method for the femur was IM nailing, either antegrade (58) or retrograde (14). IM nailing of the tibia was performed in 59 cases. Infection occurred at one site in 14 patients and non union in 25. A multivariate analysis did not show any significant increased risk of non union or different clinical result when using a retrograde nailing technique (single knee incision) except a shorter mean operating time (177’ vs. 132’, p=0.0144) and a shorter mean total surgical procedure (155’ vs. 240’, p< 0.0001). The Karlstrom’s score at the latest follow up was obtained in 86 patients (2–4.5 years) and was rated as good or excellent in 63,4% of cases in type 1 injuries versus 16,7% in type 2.

Conclusion: Floating knee injury remain a rare lesion showing extremely bad prognosis factors in general although clinical results remain closely correlated to intra articular involvement at the fracture site.

Purpose: Shaft fractures are not uncommon in elderly subjects who have proximal osteosynthesis material. There are several options for the surgical technique and the fixation method, the choice depending on their aggressiveness.

Material and methods: Between January 1998 and January 2002, retrograde nailing with proximal locking using the fixation screws already in the femur was used for eight women aged 79–99 years (mean 92). The classical ascending nailing procedure was used to insert a Russell-Taylor nail in six patients and a supracondylar Stryker nail in two. The proximal locking was used by apposing the fixation screw, which implied coinciding the locking holes in the nail with the plate screws. This required using only one screw for locking in some cases because of the distances between the holes.

Results: There were no infectious complications. Fracture alignment was correct in all cases. Subjectively, total recovery of motion and independence was achieved. Likewise for pain relief although assessment was difficult. Bone healing was achieved in four months. Secondary varus displacement occurred due to insufficient hold of the proximal locking screw in the medial cortical.

Conclusion: Although not perfect, the retrograde nail locked in the proximal implant provides a satisfactory solution for these often debilitated elderly patients. This option enables a minimally aggressive operation allowing a composite osteosynthesis protecting the entire femur without imposing points of peak stress.