Management of Ipsilateral Femur and Tibia Fractures, with Retrograde and Antegrade Nailings from the Knee

PURPOSE: To review the results in the management of ipsilateral femur and tibia fractures, using femoral and tibial intramedullary nailings with single incision on the knee. MATERIALS AND METHODS: We treated 19 cases of ipsilateral femur and tibia fractures (floating knee), and the retrograde femoral nailing and antegrade tibial nailing were done with single incision on the knee. Except one patient of early death, 18 patients were included in this study. The mean age of index procedure was 34.1 years, and all of them had follow-up study for a mean of 2.4 years. The mean injury severity score was 18.8, and 12 patients had other fractures in the lower extremity. RESULTS: Primary union was achieved in all, but one patient of femur and two of tibia. The average period for union was 27.6 weeks for femur and 24.5 weeks for tibia. One femoral nonunion occurred due to the metal failure after using short nail, and two tibial nonunion were caused by the bone loss with open tibial fractures. Most patients showed no limitation in knee motion. According to Karlstrom-Olerud criteria, functional results showed 14 excellent, 3 good and 1 acceptable. The protrusion of nail tip into the knee joint made the acceptable result with moderate limitation of knee motion, but it improved after the removal of nail. CONCLUSION: CONCLUSION: Simultaneous retrograde femoral and antegrade tibial nailing with single incision on the knee, with an appropriate technique, can achieve the satisfactory result in the management of the ipsilateral femur and tibia fractures.

A Clinical Study of Ipsilateral Fracture of the Femur and Tibia / 대한정형외과학회잡지

Ipsilateral fracture of the femur and tibia is also called “floating knee”. And it is well known that its treatment is difficult and functional result is poor in most cases because it has often comminuted, open fracture with severe soft tissue injuries. Authors reviewed 20 cases in 18 patients which were treated from September 1989 to March 1993. All were followed for more than one year. The results were as follows: 1. Among 20 cases of femoral fracture, 15 cases were treated with internal fixation and others with external fixation and among 18 cases of tibial fracture(2 amputations excluded), internal and external fixation were equal in number. 2. The bony union time was shorter in the intramedullary nailing than the plate and screws, and external fixations. 3. The end result was better in Group I(internal fixation for both fracture) than Group II (one or both fractures were treated with external fixator) because the femur had less severe comminution, and soft tissue injuries. 4. There were many complications in Group II than Group I, That is, wound infections, delayed union or non-unions. There were 11 operations for the treatment of complications,.

Clinical Study of Ipsilateral Fracture of the Femur and Tibia / 대한정형외과학회잡지

Usually the condition of ipsilateral fracture of femur and tibia is called floating knee, it is termed applied to the flail knee joint segment. The key point of the treatment is focused to the early restoration of the knee function. We experienced 86 consecutive cases during the period from March 1978 to February 1991 in Yonsei University Wonju College of Medicine. Among them, 51 cases(above 16 years old) were analysed with the mean follow up period of 2.1 years(1.2-5.6 years). The results obtained were as follows: 1. Main cause of these fractures is traffic accident. Among them, the pedestrian accident is more than in-car accident. 2. The cases of open fracture were 13 cases (25.5%) in femur and 31 (60.8%) in tibia. The degree of open fracture was more severe in tibia. 3. There were 2 cases (3.9%) of fat embolism syndrome preoperatively. 4. At an average 25 months follow up after injury, the good and excellent result of the group 1 and 3 was 85.2%, and the group 2 and 4 was 71.4% by Karlström and Olerud criteria. 5. At the last follow up examination, the mean loss of range of motion of the knee was 5.6° in group 1 and 3, 10.9° in group 2 and 4(P < 0.05). 6. The operative treatment of the both side is better than case of one side operation and other side conservative treatment.

A Treatment of Ipsilateral Shaft Fracture of the Femur and Tibia in Adult / 대한정형외과학회잡지

Twenty-eight cases of fracture of the femur and tibia on the same leg were treated in Pusan Maryknoll Hospital during the period from April 1981 to Jun 1988. We studied all of these patients, divided by five groups according to the method of treatment, with analysis of treatment and end results. The following results were obtained. 1. The incidence of trauma was high in the young man, and most frequent in the third decade (42.9%). 2. The main cause of injuries was traffic accident; 22 patients (78.6%). 3. The common fracture site was middle one-third in femur and tibia respectively. 4. The most common associsted injury was head trauma (9 case). 5. The average healing time of fracture was 20.7 weeks in femur and 22.7 weeks in tibia of group 3, 4, 5. 6. The best results were obtained in cases both fractures stabilized surgically.

The Treatment of Ipsilateral Fracture of the Femur and Tibia / 대한정형외과학회잡지

Fractures of the femur and tibia on the same leg encountered with forceful trauma. In these fractures, the treatment was difficult and the functional result was poor in most cases. Authors treated 22 fractures of femur and tibia on the same leg and analysed it. And the results were as follows. 1. The most common location of fractures was mid-third in both femur and tibia. 2. The shape of fractures was transverse or comminuted in most cases in femur and tibia. 3. Among the method of treatment of femoral fractures, the results were better in intramedullary-nailing group than plate and screw fixation group. There were three poor results in intramedullary-nailing group. These were attributed to the severity of combined tibial fractures. 4. Among the method of treatment of tibial fractures, the results were better in external fixation group which minimized the soft tissue injury than plate and screw fixation group. 5. According to the criteria of Karlstrom and Olerud, the final results were relatively good in 54% of cases. For the better results, it seemed to be needed initial careful planning and attention for the treatment.

A Clinical Study of Ipsilateral Fracture of Femur and Tibia / 대한정형외과학회잡지

Twenty-six cases of fracture of the femur and tibia on the same leg were treated in Masan Koryo General Hospital during the period 1981 1986. We studied all of these patients, divided by four groups according to the method of treatment, retrospectively with analysis of treatment and end results. The results were as follows : 1. Twenty-two patients were male and four patients were female. Of twenty-six patients, eighteen patients were at their third and fourth decades. 2. The main cause of injuries was traffic accident; 23 patients(88%). 3. The most common concomitant injury was fracture and dislocation in other site(14 cases). The fat embolism developed in one case and one patient had died due to head injury. 4. The average healing time of fracture was 17 weeks in femur and 20 weeks in tibia in group three, that was most rapid of all groups. 5. A good or excellent functional result was achieved in 87% of the patients treated with internal fixation of both fracture, 75% of the patients with internal fixstion for the femur fracture and external fixation for the tibial fracture, and 25% of the patients trested conservatively.

Ipilateral Fracture of Femur and Tibia / 대한정형외과학회잡지

Seventy consecutive ipsilateral fracture of the femur and tibia in sixty-eight patients from December 1974 through December 1984 treated at Severance Hospital were analysed in clinical and radiological aspect. 1. Fifty-nine patients were male and nine patients were female. The male patients were more injured in the ratio of 6: 1. The avarage age was 34. 2. The main cause of injuries were traffic accidents; 59 patients. (86.8%). 3. The majority of the fractures were shaft fracture; for example, femur shaft 57% and tibia shaft 47%, The open fracture of the tibia was 34% and the femur was 17%. 4. There were 24 cases of concomitant fracture and dislocation of other sites. A fat embolism was disgnosed in 4% of the patients. Four patients had died one month after sustaining injuries. 5. Over-all, a good or excellent functional result was achieved in 76% of the patients treated with internal fixation of both fracture, 65% of the patients with intexnal fixation for the femur fracture only and 35% of the patients managed conservatively.

Clinical Study on Ipsilateral Fracture of The Femur and Tibia / 대한정형외과학회잡지

Twenty-six cases of fracture of the femur and tibia on the same leg in twenty-five patients were treated at the Dept. of Orthopedic Surgery, Kyungpook National University Hospital during the period of 1973 to 1979. Twenty-two patients were sustained by the motor vehicle accident. Open fractures of the femur and tibia were ten cases, and closed femur fracture and open tibia fracture were twelve cases. Concomitant Injuries were brain Injury in eight patients and hemorrhagic shock In seven patients. Eight patients were treated by internal fixation (Kuntschernall or Compression plate) on femur and by conservative treatment on tibia. Conservative treatment was done in eleven patients on both femur and tibia fracture. Five patients were amputated. Average healing time of fracture was: twenty-two weeks in femur and twenty-seven weeks in tibia. Functional end results were assessed and rated with satisfactory results In six patients and fair and poor in elght patients respectively.