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Bones of the Lower Limb: Femur and Patella01:16

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The femur is the body's longest and strongest bone spanning the thigh region. Its head articulates with the acetabulum of the hip bone to form the hip joint. A minor indentation on the medial side of the femoral head, called the fovea capitis, serves as the site of attachment for the ligament of the head of the femur. This weak ligament spans the femur and acetabulum and supports the hip joint. The narrowed region below the head is the neck of the femur. The inclination angle between the...
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The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
A total of seven ligaments support the knee joint. The patellar ligament, which is also attached to the quadriceps femoris...
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Bones of the Lower Limb: Tibia and Fibula01:10

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The tibia is the main weight-bearing bone of the lower leg. It is larger than the fibula with which it is paired. The tibia is also the second longest bone in the body and is located right below the skin. The proximal end of the tibia forms the medial and the lateral condyle, which articulates with the condyles of the femur to form the knee joint. Between the articulating surfaces is the irregular elevated area known as the intercondylar eminence that serves as the inferior attachment point for...
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Muscles that Move the Leg01:23

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The movement of the legs is facilitated by numerous muscles located within the anterior, medial, and posterior compartments of the thigh.
Anterior Compartment
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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Muscles of the Leg that Move the Foot and Toes01:28

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The human leg comprises an intricate system of muscles that facilitate the movement of feet and toes. Within this system, the muscles are categorized into the anterior, lateral, and posterior compartments, each with a unique set of muscles carrying out specific functions.
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Pseudofracture: An Acute Peripheral Tissue Trauma Model
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Floating Knee Injuries: Beyond Bony Fractures of Femur and Tibia.

Prahalad Kumar Singhi1, Sivakumar Raju1, M Chidambaram1

  • 1Preethi Hospital, Tamil Nadu, 50 Melur Main Road, Uthangudi, Madurai, 625107 India.

Indian Journal of Orthopaedics
|March 30, 2026
PubMed
Summary

Floating knee injuries are severe traumas impacting young earners. A new classification system helps predict hospitalization, procedures, complications, and functional outcomes for better management.

Keywords:
Associated injuriesConglomerated comprehensive classificationFloating knee injuryPrognostic factorsSocioeconomic impact

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Area of Science:

  • Orthopedic Surgery
  • Trauma Management
  • Biomechanical Engineering

Background:

  • Floating knee injuries represent complex high-energy trauma involving ipsilateral femur and tibia fractures.
  • These injuries often present with associated intra-articular fractures, comminution, soft tissue damage, neurovascular compromise, ligamentous injury, and systemic trauma, significantly influencing patient outcomes.
  • The substantial socioeconomic burden is notable, as affected patients are typically young and primary wage earners.

Purpose of the Study:

  • To evaluate the utility of a novel, conglomerated comprehensive classification system for floating knee injuries.
  • The classification incorporates prognostic factors to predict hospitalization duration, number of procedures, complications, and functional outcomes.
  • To assess the system's effectiveness in guiding management and improving patient prognoses.

Main Methods:

  • Prospective analysis of 201 cases of floating knee injuries managed between 2012 and 2023.
  • Adherence to Advanced Trauma Life Support (ATLS) protocols for patient selection (stable or borderline stable).
  • Functional outcomes were evaluated post-union using the modified Karlstrom and Olerud scoring system.

Main Results:

  • Hospitalization duration, number of procedures, and complication rates were significantly higher in Types II and IV, and further escalated in Subtypes B and C of the classification.
  • Poorer functional outcomes correlated with increased injury severity (Types II/IV, Subtypes B/C).
  • Hospital stay and procedure numbers were linked to socioeconomic impact, while complications adversely affected the return to pre-injury functional levels.

Conclusions:

  • Floating knee injuries result in considerable morbidity and socioeconomic consequences.
  • The developed comprehensive classification system facilitates systematic management and accurate prognostication.
  • Early identification and prompt management of injury modifiers are crucial for reducing complications and enhancing the return to pre-injury function.