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Floating knee injuries may have higher rates of complications and morbidity than femoral or tibial fractures

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ORLANDO, Fla. — Patients who sustain a floating knee injury in addition to a femoral or tibial fracture may have higher rates of complications, such as amputation and mortality, according to a presentation by Ronald Auer, MD, at the American Academy of Orthopaedic Surgeons Annual Meeting.

“Floating knee injuries remain high-energy fractures that carry significant morbidity and mortality,” Auer said.

Auer and his colleagues evaluated 8,931 patients with femur or tibia fractures from a single institution’s database between 2010 and 2012. OTA/AO and Fraser classifications of injury were determined via a review of multiple imaging studies. Information regarding patient demographics, complications, hospital stay and radiographic outcomes also were noted. Bilateral floating knee injuries were treated and analyzed as separate injuries.

Overall, 66 floating knee injuries were found in 63 patients (0.07%). The breakdown in terms of Fraser classification of these injuries was 41% type 1, 30% type IIA, 12% type IIB and 17% type IIC. Average Injury Severity Score (ISS) for these injuries was 21, and five in-hospital deaths and three amputations were noted in this cohort. Fraser type IIB injuries had a significantly higher deviance from the average ISS, while type I injuries had a significantly lower deviance (ISS scores of 30 and 20, respectively). Average age of patients with floating knee injury was 38.5 years. Fraser type I and type IIC injuries had the lowest and highest average ages (32 years and 45 years, respectively).

The initial treatment for 70.5% of patients with both femur and tibia fractures was external fixation. Femoral fractures and tibial fractures were definitively treated with intramedullary fixation in 64.7% and 45.1% of cases, respectively. In 24% of patients treated with intramedullary nailing, a single incision was used. Significant complications observed by the researchers included acute compartment syndrome, nonunion, infection, peri-implant fracture and amputation. — by Christian Ingram

Reference:

Auer R, et al. Paper #135. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 1-5, 2016; Orlando, Fla.

Disclosure: Auer reports no relevant financial disclosures