Floating Knee

Abstract

Surgery of both fractures (tibial and femoral) is advisable for the treatment of floating knee, except in non-displaced and stable fractures, where combined treatment could be considered (surgery for one of the fractures and conservative management for the other). In diaphyseal fractures it is advisable to perform intramedullary nailing (anterograde or retrograde, with or without drilling), depending on the characteristics of the fracture and the preferences of the surgeon. Non-displaced intraarticular fractures should be treated by percutaneous fixation and early mobilization. Displaced intraarticular fractures in turn require anatomical reduction and internal fixation. The femoral fracture is usually stabilized first, thereby avoiding the risk of secondary displacements if tibial fracture stabilization were performed first. Manual traction without large angulations is required in order to avoid displacements of the tibial fracture during femoral fracture reduction. After fixation of the femoral fracture the knee can be flexed to secure a better access for insertion of a tibial nail. In floating knees with an open tibial fracture, the wound must be correctly irrigated and debrided before surgical stabilization of the femoral fracture. The tibial fracture can be stabilized using external fixation in order to reduce additional soft tissue damage during manipulation of the femoral fracture. Such fixation can be replaced by nailing or can be maintained as definitive treatment, depending on the severity of the soft tissue damage. After surgical stabilization of the femoral and tibial fractures, and provided the patient condition is acceptable, clinical and imaging evaluation of the stability of the knee is indicated in order to diagnose and posteriorly treat possible ligament damage.