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,.