Floating Knee

Table Of Contents

• Introduction

• What is a Floating Knee?

• Types of Floating Knee Injuries

• Complications of Floating Knee Injuries

• Management of Floating Knee Injuries

• Conclusion

Introduction

A floating knee is a severe injury involving fractures of both the femur (thigh bone) and tibia (shin bone) in the same leg, creating a “floating” joint. This condition, usually caused by high-energy trauma such as car accidents or falls from significant heights, was first described by Blake and McBryde in 1975. It represents a rare and complex injury requiring prompt and specialized treatment to prevent severe complications.

What is a Floating Knee?

A floating knee results from simultaneous fractures of the femur and tibia on the same leg, leading to a flail knee joint characterized by instability due to damaged supporting ligaments. This instability can cause pain, swelling, and difficulty in movement. The high incidence of open fractures, vascular injuries, and nerve damage makes this condition particularly challenging to manage.

Types of Floating Knee Injuries

Floating knee injuries have been classified using various systems to better understand and treat the condition. Here are some key classification systems:

Blake and McBryde Classification

1. Type I: Fractures of both shafts of the two long bones.
2. Type II-A: Fractures involving the knee joint.
3. Type II-B: Fractures involving the hip or ankle joints.

Letts-Vincent Classification (Pediatric)

1. Type A: Two closed diaphyseal fractures.
2. Type B: One closed diaphyseal and one metaphyseal fracture.
3. Type C: One diaphyseal and one epiphyseal fracture.
4. Type D: At least one open fracture.
5. Type E: Both fractures are open.

Bohn-Durbin Classification (Pediatric)

1. Type I: Double shaft fractures.
2. Type II: Juxta-articular injuries.
3. Type III: Fractures with an epiphyseal component.

Fraser Classification

1. Type I: Shaft fractures of both bones without knee involvement.
2. Type II: Fractures extending into the knee.
   • Type II a: Tibial plateau involvement.
   • Type IIb: Distal femur involvement.
   • Type II c: Both tibial plateau and distal femur involvement within the knee joint.

Complications of Floating Knee Injuries

Floating knee injuries can lead to various complications, including:

• Epiphyseal injury: May affect open growth plates in children, causing limb-length discrepancies and deformities.
• Infections: Due to open fractures.
• Nonunion and malunion: Improper healing of fractures.
• Knee stiffness: Resulting in functional impairment.

Management of Floating Knee Injuries

Immediate medical attention and stabilization are critical for patients with floating knees to prevent further damage and address associated injuries. Treatment typically involves surgical stabilization of the fractures, followed by a comprehensive rehabilitation program.

Physiotherapy Rehabilitation

• Post-surgical Examination: Assess range of motion and stability.
• Ligament Reconstruction: Usually delayed until skeletal injury rehabilitation is adequate.
• Pain Control: Essential in the early postoperative phase, often managed with epidural catheters or systemic opioid infusion.
• Weight Bearing:
  • Type I: Delayed until callus formation is visible on radiographs.
  • Type II: Permitted only after 10 weeks.
• Early Mobilization: Crucial for optimal recovery, especially in cases involving intra-articular fractures.

Conclusion

Floating knee injuries represent a complex and severe form of trauma requiring prompt, specialized medical intervention and comprehensive rehabilitation. Understanding the types, complications, and management strategies for floating knees is essential for healthcare providers to ensure the best possible outcomes for patients. With proper treatment and rehabilitation, patients can regain function and mobility, minimizing long-term complications.

 

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