Management of floating knees in adults: experience from tertiary hospital

Background: Floating knee is the term applied to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur and tibia. The fractures are often a result of high­energy trauma. Objectives: The aim of this study was to determine the pattern and distribution of these fracture types, mechanism of injury, associated injuries, method of treatment, complications, and the challenges encountered during the course of managing these patients. Patients and Methods: This is a retrospective study of all cases of floating knee injuries presenting to the Orthopedic Unit of Federal Medical Center and Surgery Department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, Northwest Nigeria, from January 2011 to December 2017. Data were extracted from the accident and emergency register, operation register, and patients' case folders. Data collected were analyzed using the Statistical Package for the Social Sciences for Windows version 22 (SPSS Inc. Chicago, Illinois, USA). Results: A total of 29 cases of floating knee injuries presented to the accident and emergency units. Males constituted 27 (93.1%) while females constituted 2 (6.9%). Motor vehicle accident was the most common mechanism of injury in 25 (86.3%) of the patients. The most common fracture type according to Fraser et al. classification is Type I which occurred in 12 (41.4%) of the patients. Conclusion: Floating knee injury occurs mostly in the productive age group. Head injury is the most common associated injury seen. This is mostly caused by motor vehicle accidents

Major extremity amputations: Indications and post surgery challenges in a Nigeria tertiary institution

Amputation is an ancient procedure which has been practiced for centuries for a variety of indications. The goal of the procedure is to eliminate potential threat to the patient while producing a viable stump for easy rehabilitation.Objective: To identify the indications, postoperative complications and peculiarities of patients with amputation in a native African population.Materials and Methods: This was a prospective study carried out on all consenting patients who had extremity amputation at Federal Medical Centre, Birnin Kebbi, from June 2015 to May 2016. Results: During the study period, there were 47 amputations in 47 patients (34 males and 13 females). The mean age of the patients was 35.73 ± 19.43 years. The most common indication for amputation was traditional bone setter's (TBS) gangrene accounting for 44.7% of cases, followed by diabetic foot syndrome at 25.5%. Camel bites accounted for 6.4% of the amputations. The most common type of amputation was below­knee amputation (46.8%), followed by above­knee amputation (25.5%). Five (10.7%) patients had surgical site infection and only 2.1% of the patients developed phantom limb sensation. None of these patients was fitted with a prosthesis due to the high cost or nonavailability of the prosthesis.Conclusion: Complications of TBS intervention were the leading cause of amputation in this study. Gangrene following camel bites was also found to be a peculiar cause for amputation in this environment. Appropriate public health interventions are necessary to reduce the incidence of preventable gangrene. Provision of prosthesis with adequate technical support is essential to proper rehabilitation of the amputees