Predictors of outcome of floating knee injuries in adults: 89 patients followed for 2-12 years

Hee, Hwan Tak; Wong, Ho Poh; Low, Y P; Myers, Leann

doi:10.1080/000164701753542050

Cited by 79 publications

(43 citation statements)

References 13 publications

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“…In our experience, the outcome of the cases in type I floating knee was better (76.6% of good and excellent results) [12], while the outcome of the cases in type II was comparatively poor. Recent reports, using multivariate analysis, also claim that the outcome of type II floating knee is poorer than that of type I [10,16,17]. In this article, we have focused on the type II floating and analyzed the reasons of poor result.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of type II floating knee: comparisons of the results of type IIA and type IIB floating knee

Hung

Huang

et al. 2007

Knee Surg Sports Traumatol Arthrosc

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The prognosis of type II floating knee injuries was not as good as that of type I. Our purpose is to clarify the factors affecting the outcome of type II floating knee injuries. Thirty-five patients (36 limbs) with type II floating knee injury were studied with a mean follow-up of 52 months (26-96). Blake and McBryde had classified these injuries into type I for pure diaphyseal (true type) fracture and type II if the intra-articular involvements are one or more including hip, knee and ankle joints (variant type). According to this classification, we divided these patients into two groups depending on whether their knees were involved or not. Those cases with intra-articular knee involvement were classified as type IIA, while those without intra-articular knee involvement were classified as type IIB. Of the 36 cases, 21 were classified as type IIA and 15 were type IIB. The functional outcomes of these injuries were evaluated by using the criteria of Karlström and Olerud and analyzed with multivariate analysis. After multivariate analysis with logistic regression, we show the following results: first, the poor functional outcome of type II floating knee is contributed by type IIA. Second, the type IIA group has severer femoral open fracture grading (P = 0.027) and poorer functional outcome (P = 0.009) than type IIB. Third, the significant contributing factors to final outcome are the group (P = 0.013) and the fixation time after injury in femur (P = 0.015). Intra-articular knee involvement is the most important factor contributing to poor outcome of type II floating knee. The treatment of floating knee injuries with intra-articular knee involvement is still difficult. Further efforts to search better methods of treatment are required for these complex injuries in the future.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of type II floating knee: comparisons of the results of type IIA and type IIB floating knee

Hung

Huang

et al. 2007

Knee Surg Sports Traumatol Arthrosc

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“…In most healthy adults immobility associated with fracture healing does not significantly impact quality of life of the patient, but in elderly patients the period of convalescence required for fracture repair is a significant cause of post-trauma morbidity and mortality [12,20]. Although there is some disagreement [25], clinicians have suggested that advanced age might delay fracture healing [7,13], which could further hinder recovery in the elderly. Understanding how the potential of fracture repair changes with age will identify novel therapeutic targets that can be exploited to improve fracture healing in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Cellular basis for age-related changes in fracture repair

Miclau

et al. 2005

J. Orthop. Res.

194

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The goal of this work was to define cellular and molecular changes that occur during fracture healing as animals age. We compared the molecular, cellular, and histological progression of skeletal repair in juvenile (4 weeks old), middle-aged (6 months old), and elderly (18 months old) mice at 3, 5, 7, 10, 14,21,28, and 35 days post-fracture, using a non-stabilized tibia fracturqmodel. Our histological and molecular analyses demonstrated that there was a sharp decline in fracture healing potential between juvenile and middle-aged animals, while a more subtle decrease in healing potential was apparent between middle-aged and elderly mice. By three days after fracture, chondrocytes expressing Collagen type ZZ, and osteoblasts expressing osteocalcin, were present in calluses of juvenile, but not middle-aged or elderly, mice. At day 5 immature chondrocytes and osteoblasts were observed in calluses of middle-aged and elderly mice. While at this time, chondrocytes in juvenile mice were expressing Collagen type X (ColX) indicating that chondrocyte maturation was already underway. At day 7, chondrocytes expressing ColX were abundant in middle-aged mice while a small domain of ColX-positive chondrocytes were observed in elderly mice. Further, in juvenile and middle-aged mice, but not elderly mice, vascular invasion of the cartilage was underway by day 7. Juvenile mice had replaced nearly all of the cartilage by day 14, while cartilage was still present in the callus of middle-aged mice at day 21 and in elderly mice at day 28. In addition to these delays, histomorphometry revealed that elderly and middle-aged mice formed less bone than juveniles (p < 0.001), while cartilage production was unaffected (p > 0.22). Collectively, these data suggest that enhancing cell differentiation, improving osteoblast function, and accelerating endochondral ossification may significantly benefit the elderly.

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“…The time required for radiographic union following femoral fracture increases with age in rats, [5][6][7] mice, 8,9 and humans. [10][11][12][13][14][15] While young 6-week-old rats form bone to bridge the fracture gap by 4 weeks after fracture, adult 26-week-old rats require 10 weeks, and older 52-week-old rats need in excess of 26 weeks. 7 Despite this increased time to healing with age, there was no increase in the time of expression of Indian hedgehog or any of the bone morphogenetic proteins in the fracture callus.…”

Section: Introductionmentioning

confidence: 99%

Young, adult, and old rats have similar changes in mRNA expression of many skeletal genes after fracture despite delayed healing with age

Meyer

Desai

Heiner

et al. 2006

Journal Orthopaedic Research

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Genes active in fracture healing are not well understood. Because age slows skeletal repair, the change in gene expression between animals of differing ages may illuminate novel pathways important to this healing response. To explore this, 6-, 26-, and 52-week-old female Sprague-Dawley rats were subjected to mid-diaphyseal femoral fracture with intramedullary fixation. The fracture callus was collected at 0, 0.4 (3 days), 1, 2, 4, or 6 weeks after fracture. RNA was extracted and pooled between two animals for each sample. Three samples were done for each time point for each age for a total of 54 Affymetrix U34A GeneChip microarrays. Of the 8700 genes on each array, 3300 were scored as present. Almost all of these genes were affected by femoral fracture with either upregulation or downregulation in the 6 weeks after fracture. Upregulated genes included markers for matrix genes for both cartilage and bone, osteoblasts, osteocytes, osteoclasts, fibroblasts, and mast cells. Downregulated genes included genes related to blood cell synthesis. Nearly all genes presently associated with bone metabolism showed the same response to fracture healing regardless of the age of the animal. In conclusion, skeletal fracture led to similar changes in RNA expression for most skeletal genes despite the delay in the formation of bone to bridge the fracture gap in old rats. Defects in the healing of skeletal trauma in older rats may lie in systems not normally studied by skeletal biologists. ß

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Predictors of outcome of floating knee injuries in adults: 89 patients followed for 2-12 years

Cited by 79 publications

References 13 publications

Surgical treatment of type II floating knee: comparisons of the results of type IIA and type IIB floating knee

Surgical treatment of type II floating knee: comparisons of the results of type IIA and type IIB floating knee

Cellular basis for age-related changes in fracture repair

Young, adult, and old rats have similar changes in mRNA expression of many skeletal genes after fracture despite delayed healing with age

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