Study of Ipsilateral Fractures of Femur & Tibia Treated With Different Modalities

Abstract

INTRODUCTION: With the modernisation there is increase in the speedy vehicles, there is sharp increase in the number of road traffic accidents. The term “floating knee injury” was first coined by Blake and McBryde in the year of 1965[1]. Floating knee injury was described by them was as “the simultaneous and ipsilateral disruption of skeletal integrity above and below the knee joint, which is usually associated with high-velocity trauma and most of the time may be a part of polytrauma”. The incidence of floating knee injuries is reported as 2.6 % of all fractures by Letts et al in 1986[2]. Most of the patients are in their 3rd decade with a high male preponderance [3]. The associated soft tissue injuries can be variable from minor superficial abrasions to open grade III injuries. Injuries to the neurovascular structures can be a catastrophic complication in the functional outcome of the limb function. MATERIAL AND METHODS: The study was conducted in the department of Orthopedics, Dhiraj General Hospital, SBKSMI&RC, Vadodara. We included 25 consecutive patients diagnosed with ipsilateral fractures of femur and tibia who were managed surgically in our hospital. All the patients were assessed clinically for the associated injuries to head, chest, abdomen and pelvis and were managed accordingly. Patients were treated with interlocking nails, external fixators, locking plates, proximal femoral nails and cannulated cancellous screws according to the fracture pattern, comminution and soft tissue injury. All the patients were operated under broad spectrum intravenous antibiotic cover. OBSERVATION AND RESULTS: The most common age group was 21-30 years with 10 out of 25 patients. All the patients were of male sex. The most common mode of trauma was motorcycle accidents in 88% of patients. Right side was injured in 84% of patients. Head injury was the most common associated injury with floating knee injuries in 32% of patients. 56% of fractures were open in femur and tibia. Only 9 (36%) patients had both closed injuries. Fraser type I (both diaphyseal) was most common in 36% of patients followed by Fraser type II C (both articular) in 32% of xi patients. The most common mode of treatment was intramedullary nailing done in 13 femoral and 10 tibial diaphyseal fractures. External fixators were done primarily in 7 femur and 8 tibia open grade II &III fractures. The average hospital stay was 39.9 days. The average union time for femur was 17.4 weeks and for tibia it was 18.4 weeks. The average follow up was 15.5 months. One patient with open grade III injury died due to late septicaemia. Non union was reported in 3 femur and 6 tibia fractures all of which were open grade II & III injuries. CONCLUSION: The incidence of floating knee injuries is increasing day by day due to increase in population and motor vehicles. As it is a high velocity injury, the associated life threatening injuries to the head, thorax, abdomen and pelvis may increase the morbidity and mortality. Open injuries are the most common cause of non union. Thus, more aggressive approach to treat floating knee injuries should be taken up to achieve good results. In our study, we had 12.5% excellent, 25% good, 20.8% satisfactory, 12.5% fair and 29.1% poor results.