Bilateral Floating Knee Injuries Managed by Intramedullary Nailing - An Unusual Injury

Floating knee injuries were first described in 1975 by McBryde as concurrent femur and tibial fractures in an ipsilateral limb. They usually occurred in a polytrauma setting and presented with poor functional outcomes with frequent post-operative complications. Management of this injury was based on patient and fracture characteristics and can be done by external fixators, plating, and nailing.

A 24-year-old female presented with bilateral floating knees. She was operated on for a left femoral fracture with retrograde nailing when she developed tachycardia and underwent external fixation of the remaining fractures. She later developed a fat embolism which was managed accordingly for the same. After adequate stabilization, her right femur and tibia fractures were fixed by intramedullary nailing through a single percutaneous approach along with nailing for the left tibial fracture. She has satisfactory clinical outcomes on follow-up.

Bilateral floating knee injuries are extremely rare injuries and should be managed on an emergency basis. Intraoperative and post-operative complications should be anticipated and managed accordingly. Good functional outcomes can be obtained by intramedullary nailing.