Floating Knee Injuries: Beyond Bony Fractures of Femur and Tibia

Floating knee injury is a complex high-energy trauma involving ipsilateral fractures of the femur and tibia. As Rethnam et. al. stated, it is much more than what meets the eye. Associated intra-articular fractures, comminution, soft tissue injury, neurovascular injury, ligamentous involvement and systemic trauma influence the outcomes. Given that most patients are young and primary earners, the socioeconomic burden is substantial. Based on past experience, we developed a conglomerated comprehensive classification comprising four types, three subtypes, and three modifiers, incorporating prognostic factors influencing outcomes. This study evaluated its usefulness in predicting duration of hospitalization, number of procedures that the patient underwent, complications, and functional outcomes.

Of 230 floating knee injuries managed from 2012 to 2023, 201 cases were prospectively analysed. Standard ATLS protocols were followed, and only stable or borderline stable patients were included. Functional outcomes were assessed after union using the modified Karlstrom and Olerud scoring system.

Statistical analysis (SPSS v19) assessed intervention type (ETC or DCO), hospitalization duration, number of procedures, complications, and outcomes. Hospital stays, procedures, and complications were higher in Types II and IV and further increased in Subtypes B and C, leading to poorer functional results. Duration of hospitalization and procedures correlated with socioeconomic impact, while complications affected return to pre-injury level.

Floating knee injuries cause significant morbidity and socioeconomic impact. The conglomerated comprehensive classification aids in systematic management and prognostication. Early identification and timely management of modifiers reduce complications and improve return to pre-injury function.