Functional outcome analysis in floating knee injury

Introduction: The term floating knee is defined as simultaneous ipsilateral fracture of femur and tibia that disconnect the knee from the rest of the limb. Due to the complexity of injury and associated complications such as compartment syndrome, vascular injury, collateral and meniscal injuries they remain as great challenge to the treating orthopaedician. Materials and Methods: Study includes 25 cases of floating knee injuries done at our institution from June 2013 to December 2016, McBryde and Blake classification was used and intramedullary interlocking nailing was done in majority of cases. All the patients were followed up for clinical, radiological outcome and complications. Functional outcome was assessed by using Karlstrom Olerud criteria. Results: In our study, mean age is 43.5 years, predominantly males (96%). McBryde and Blake type I (52%) was common. The average hospitalization period is 45 days. Minimum follow up period was 4 months. The average fracture union time was 24 weeks for tibia and 25 weeks for femur. The most common complications noted was shock (68%), knee stiffness (44%),chronic osteomyelitis (20 %), malunion (16%), non union (16%),vascular injury with amputation(4%). Functional outcome based on above criteria is excellent in 40%, good in20%, acceptable in 20% and poor in 28%. Conclusion: Each fracture in floating knee is unique and treatment should be individualized. In compound fractures early stabilization with external fixator followed later by definitive fixation avoid the late complication. In closed fractures early internal fixation and rehabilitation will give a good functional outcome.