Management of the Floating Knee in Polytrauma Patients

Abstract

Ipsilateral fracture of the femur and tibia, or floating knee, is a rare injury that is found almost exclusively in polytrauma or high-energy trauma patients. It presents a combination of diaphyseal, metaphyseal and intra-articular fractures of the femur and tibia, with a high incidence of neurovascular, ligamentous and soft-tissue injuries. The functional outcome and, in some cases, the life, of such polytrauma patients depends largely on a correct therapeutic approach being taken. In general, the treatment decided upon will depend on the individual characteristics present, regarding aspects such as the patient’s general condition, the fracture line and the state of the soft tissues. The treatment provided may be the same as when single fractures are presented, but it is often necessary to consider whether certain techniques or surgical approaches may interfere with other lines of treatment. It is essential at all times to take into consideration the associated injuries and complications before deciding upon a treatment strategy. Ligamentous injuries play an important role in these injuries, much more so than when fractures occur singly. Therefore, these injuries require management by an experienced multidisciplinary team.

Complex pelvic ring injuries associated with floating knee in a poly-trauma patient

“…[ 14 ] Standard practice is anterograde femoral nailing to be performed first, followed by anterograde tibia nailing. [ 19 ] However, the surgical program depends on not only the fracture type but also the age, complications, patient's general conditions, and the conditions of the soft tissue and skin.…”

Floating knee management

“…Other clinical scenarios where plating of the distal femur and proximal tibia could be appropriate are fractures of the femur or tibia with pre-existing deformity (in which case a nail can cannot be used), when nail entry points of the nail (soft-tissue infection around the entry points) and in situations of damage control orthopedics and fat embolism syndrome [27].…”

Avaliação da concordância interobservador das classificações de Fraser e Blake & McBryde para joelho flutuante

“…No entanto, observa-se um crescimento do número de casos de joelho flutuante no últimos anos, o que se manifesta proporcionalmente ao aumento da quantidade de pacientes acometidos por traumas de alta energia. 2 Em decorrência do seu mecanismo de trauma (alta energia), os episódios de joelho flutuante, muitas vezes, são associados a outras injúrias de importância traumato-ortopédica, como fraturas em outros sítios ou lesões ligamentares de joelho. Além disso, pelo mesmo motivo, pode haver também injúrias ameaçadoras a vida, como traumas cranioencefálicos, torácicos ou abdominais.…”

“…Além disso, pelo mesmo motivo, pode haver também injúrias ameaçadoras a vida, como traumas cranioencefálicos, torácicos ou abdominais. 2 A gravidade dessas lesões se reflete na mortalidade, que varia de 5 a 15%, segundo a literatura. Estudos mostram ainda grande número de fraturas expostas (59-67% dos casos) e elevada quantidade de casos (20-30%) que necessitem de amputação.…”