Purpose: The floating knee injuries are rare injuries and have severe complications. There is controversy in the literature regarding the gold standard of treatment. We present our experience treating 25 patients with this type of injury.

Materials and Methods: There were 23 males and 2 females, aged 18 to 65 years, with a mean ISS (injury severity score) 25 (ranged, 18 to 45). All patients were operated the day of admission. Based on Letts’ classification there were 8 fractures type A, 6 type B, 7 type C, and 4 type D. The management in type A and B in non polytrauma patients was external fixation of the tibia followed by intramedullary nail of the femur, while in type C and D external fixation of the femur followed by external or internal fixation of the tibia.

Results: The mean follow-up was 4 years (ranged 1–7 years). One patient died before the completion of the therapy. Fracture union was accomplished to all the patients. Three patients were reoperated for nonunion or malunion of the femur and one for nonunion of the tibia. There was no infection. The main complication was the knee stiffness but it was resolved without a second operation. Two patients had pulmonary embolism and one fat embolism. The final results based on Karlstrom and Olerud criteria were excellent in 5 patients, good in 14 and fair in 5.

Conclusion: The treatment of the floating knee injuries is based on ISS and the Letts classification. In type A and B in non polytrauma patients, we believe that the best way of treatment is external fixation of the tibia followed by intramedullary nail of the femur.