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Development of the D-FLLIP classification for ipsilateral floating hip and knee injuries.
M A Altamirano-Cruz1, F Hernández-Aceves2, S Q Rodríguez-Lara3
1UMAE Centro Médico Nacional de Occidente IMSS, Encargado del Módulo de Politrauma, Pelvis y Acetábulo, Guadalajara, Jalisco, Mexico.
Revista Espanola De Cirugia Ortopedica Y Traumatologia
|April 22, 2026
Summary
The Diagnostic Floating Lower Limb Ipsilateral Protocol (D-FLLIP) offers a new grading system for complex leg fractures, correlating with injury severity and patient outcomes. This tool aids in early triage and management of high-energy trauma.
Area of Science:
- Trauma surgery
- Orthopedic surgery
- Emergency medicine
Background:
- Ipsilateral "floating lower limb" (FLL) involves coexisting pelvic, femoral, and tibial fractures, representing rare, high-energy trauma.
- This complex injury pattern presents significant limb-threat physiology, necessitating improved early triage and operative sequencing.
Purpose of the Study:
- To develop and preliminarily evaluate the Diagnostic Floating Lower Limb Ipsilateral Protocol (D-FLLIP).
- To establish D-FLLIP as an ordinal severity classification and early decision-support tool for FLL injuries.
Main Methods:
- Retrospective, single-center case series of 28 consecutive FLL patients (2018-2023).
- Patients were graded I-V using D-FLLIP based on pelvic, femur, tibia, and soft-tissue domains.
- Exploratory logistic regression assessed acute complication discrimination; Kruskal-Wallis and Fisher's exact tests compared variables across grades.
Main Results:
- D-FLLIP grade distribution: I (25%), II (39.3%), III (21.4%), IV (7.1%), V (7.1%).
- Stepwise increases in ICU length of stay and peak lactate observed with higher grades (p=0.0357, p=0.0128).
- Vascular injury and amputation rates increased significantly with higher grades (p<0.01); moderate discrimination for acute complications (AUC≈0.69).
Conclusions:
- D-FLLIP provides a pragmatic, standardized early-severity framework for FLL injuries.
- The protocol aligns with clinical gradients in ICU use, metabolic derangement, and limb-threat events.
- Prospective multicenter validation is warranted to refine clinical implementation.
