Early treatment outcomes of patients with ipsilateral fracture of femur and tibia as managed at Muhimbili Orthopaedic Institute

Abstract

Introduction: Floating knees are rare fractures occurring in long bones involving ipsilateral fracture of the femur and tibia; Floating knee injuries may include a combination of diaphyseal, metaphyseal, and intra-articular fractures. They are complex fractures caused by high energy trauma mostly associated with other significant injuries. Objectives: The objective of this study was to evaluate the causes of injury, fracture pattern, treatment modality and functional outcomes of floating knee injury patients at Muhimbili Orthopaedic Institute (MOI) –Dar es Salaam from March 2014 to Feb 2015. Methodology: This was a hospital based descriptive prospective study done to patients aged 15 years and above who presented with floating knee injuries at MOI between March 2014 and February 2015. A structured questionnaire to collect data from the participants was used, clinical and radiological evaluations were done to classify the fracture patterns. The patients were followed-up post-operatively at the 2nd, 6th, 12th and 18th week. Each patient was followed up for a minimum of 18 weeks and their functional outcomes scored using the Karlstrom and Olerud criteria. The data was analyzed by SPSS version 2.0. Results: A total of 44 patients with floating knee injuries were enrolled. Males were 41 (93.2%) and females 3(6.8%) giving an M:F ratio of 13.7:1 and mean age of (33.05±11.23) years. Motor traffic crash was the most common cause of injury 42(95.4%) in which Motorcyclists were mostly affected 20(47.6%). Fraser type I was the most common type accounting for 29(65.9%).Type IIA accounted for 3(6.8%), type IIB 7 (15.7%) and IIC 5(11.4%).75% had open floating knee injuries. Associated injuries were seen in 29(66%) of all floating knee patients with head injury being the most common 14(32%). Both operative and non-operative management were used either as temporary measure or definitive. Skeletal traction was commonly used in the femur 15(34.1%) as a temporary measure and external fixator in tibia by 23(52.3%). In femur fracture intramedullary nailing were most used as definitive method of treatment in 32 (72.7%), followed by Plaster of Paris in 6(13.6%), EF in 3(6.8%), plate /screw fixation in 2(4.6%) and one underwent above knee amputation (2.3%). For the tibia definitive management using Plaster of Paris was most frequently used 22(51.1%), followed by external fixation in 9(20.9%), intramedullary nailing in 7(16.3%) and plate fixation in 3(7%). Two patients underwent below knee amputation and one were loss to follow up. The functional outcomes of the patients with floating knee injuries using Karlström and Olerud criteria found excellent in 5(12.5%), good in 15(37.5 %), acceptable in 8(20%) and poor in 12 (30%). Conclusion Floating knee injuries are complex fractures and are commonly due to high energy trauma. Young active males were the most affected. Motor traffic crash was the most common cause of injury. Motorcyclists were the most common victims seen. Extra articular fractures were commonly seen and had better functional outcomes compared to intraarticular floating knee injury. Most floating knee injuries were associated with other injuries .Both modes of treatment were used operative and non-operative. Excellent results were seen more in operative treatment than in non-operative treatment.