Functional and Radiological Outcome Following Imil Nailing for Floating Knee

Abstract

Introduction:  The term "Floating Knee" denoted fractures that occur simultaneously on the same side of the tibia and femur, resulting in the knee joint flailing. Typically caused by high-energy traumas, like motor vehicle accidents or falls from height, these injuries present challenges due to related consequences like vascular injuries, compartment syndrome, and ligament damage. The study aimed to evaluate various surgical treatments for floating knee injuries, considering factors influencing prognosis and complications.

Patients and Methods: A prospective survey of 15 patients with Frazer type 1 floating knee injuries, conducted from April 2022-2023, involved clinical and radiographic assessments. Exclusions encompass skeletally immature patients, those unfit for surgery, extensive soft tissue injuries, knee ligament involvement, intraarticular fractures, and pathological fractures. All patients underwent thorough preoperative evaluations, with treatment including intramedullary nailing. Postoperative rehabilitation and follow-up were integral components of the study.

Results: The study involved 15 patients (mean age 30.9 years) with floating knee injuries, predominantly because of RTAs (Road Traffic Accidents). Intramedullary nailing for the femur, as well as tibia fractures, exhibited an average surgery duration of 2 hours 32 minutes and an average blood loss of 270 ml. Complications, including knee stiffness and infections, were managed effectively. Follow-up assessments according to Karlstrom's criteria revealed excellent results in 20%, good in 60%, and acceptable in 20% of cases.

Conclusion:The floating knee injury involves complexities impacting prognosis beyond simultaneous fractures of the femur and tibia. A meticulous initial assessment, prioritizing the identification of life-threatening related injuries, is crucial. Surgical fixation, preferably through intramedullary nailing, along with early and intensive postoperative rehabilitation, is recommended for improved functional and radiological outcomes.