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Paper Information

Journal:   IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY   SPRING 2006 , Volume 4 , Number 3 (15); Page(s) 11 To 16.
 
Paper: 

FLOATING KNEE AND VASCULAR INJURY

 
 
Author(s):  KARIMI MOBARAKEH M.*, FADAEI M.H., MEHDI NEZHAD YAZDI M.
 
* KERMAN UNIVERSITY OF MEDICAL SCIENCES
 
Abstract: 

Background: Ipsilateral fractures of femur and tibia, the so called “floating knee” are usually the result of high-energy trauma. They are associated with increased risk of local soft tissue injures around the knee including ligamentous injuries, delayed union, and more importantly, vascular injuries. We are reporting our experience with such fractures in a teaching hospital.

Methods: A cross sectional study of “floating knee” injuries treated in Shahid Bahonar hospital of Kerman over a 1 year period (2003 to 2004) was performed. Seventy eight patients (69 males, 9 females), with a maximum follow-up of 2 weeks entered the study and are reported here. The injury type and, in particular, the vascular status of the limb in terms of prevalence and the fate of limb in first two weeks were the points of concern. Seventy eight “floating knee” patients comprised the study group that was divided into six groups in accordance with the limb vascular status. Group 1: Forty nine cases with normal pulses and normal capillary refill; group 2: Seven cases with low blood pressure and poor pulse, but intact capillary refill; group 3: Thirteen cases with no pulse and no capillary refill, and ischemic time of below 6 hours that had angiographic studies; whit severe crushing and vascular compromise referring 24 hours later who underwent amputation; group 6: Two patients who developed vascular compromise after fracture fixation. Each “floating knee” case was further classified according to the level and type of each bone fracture.

Results: Out of 78 cases 18 had no pulse and did not regain any hemodynamic stabilization, and 13 had angiography and 5 went directly for arterial exploration. In general 15 cases (19.2%) of “floating knee” had vascular compromise, 8 of whom ended up with amputation. The vascular damage had no direct correlation with age, or anatomic location of fractures.

Discussion: Simultaneous ipsilateral fractures of femur and tibia are associated with around 20 percent chance of vascular injury. Careful and immediate assessment of limb circulation is mandatory for any “floating knee” injuries.

 
Keyword(s): KNEE JOINT, TRAUMA, ARTERIES, BLOOD VESSELS
 
References: 
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