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Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
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 23, 2026
Summary
The Diagnostic Floating Lower Limb Ipsilateral Protocol (D-FLLIP) offers a new grading system for severe leg injuries, improving early assessment and management of complex fractures. This tool shows promise in predicting patient outcomes and guiding treatment decisions for floating lower limb trauma.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Floating lower limb (FLL) is a rare, high-energy trauma involving pelvic, femoral, and tibial fractures.
- It presents complex limb-threatening physiology requiring precise triage and surgical planning.
- A standardized diagnostic framework is needed to improve early management.
Purpose of the Study:
- To develop and evaluate the Diagnostic Floating Lower Limb Ipsilateral Protocol (D-FLLIP).
- D-FLLIP serves as an ordinal severity classification and decision-support tool for FLL injuries.
- To assess its preliminary efficacy in a clinical setting.
Main Methods:
- Retrospective case series of 28 FLL patients (2018-2023) at a tertiary trauma center.
- Patients were graded I-V using D-FLLIP based on fracture domains and soft-tissue status.
- Statistical analyses compared D-FLLIP grades with clinical outcomes like ICU stay, lactate levels, and acute complications.
Main Results:
- D-FLLIP grade distribution showed a higher prevalence of grades I and II.
- Higher D-FLLIP grades correlated with increased ICU length of stay, peak lactate, and risk of vascular injury or amputation.
- The protocol demonstrated moderate discrimination for acute complications (AUC ≈ 0.69).
Conclusions:
- D-FLLIP provides a pragmatic, standardized framework for assessing FLL injury severity.
- The protocol aligns with clinical outcomes, including ICU utilization and limb-threat events.
- Further prospective multicenter validation is recommended to refine clinical implementation.
