Major Limb Replantation of Lower Leg Amputation with Ipsilateral Distal Femoral Comminuted Fracture in Old Age: A Case Report

The development of microsurgical techniques has also increased the success rate of replantation surgery. This paper reports the results of limb replantation performed on a lower extremity amputation that was associated with crush amputation and an ipsilateral comminuted fracture in and elderly patient. A 68-year-old female presented with a right distal tibia amputation due to a traffic accident. At that time, with a comminuted fracture in the distal femoral condyle, simple wound repair was recommended, but the caregivers strongly wanted replantation. Three years after surgery, normal walking was possible without a cane and the patient was satisfied with the function and aesthetics. What used to be contraindicated in limb replantation in the past are now indications due to the development of microsurgical techniques, surgical experience, and postoperative rehabilitation treatment. If the patient is willing to be treated, good results in contraindications can be obtained.

Ipsilateral Femoral Segmental and Tibial Fractures : A Case Report

The ipsilateral femoral segmental and tibial fractures seldom occur such as traffic accidents needed high energy mechanisms. For these fractures, surgical stabilization and early mobilization of joint produce can be the best clinical outcomes. We have experienced a case of ipsilateral femoral segmental and tibial fracture and gained good clinical results with surgical treatment. We have reported here on this case and included a review of the relevant literature.

Instability of Knee Associated with Ipsilateral Femoral and Tibial Shaft Fractures

PURPOSE: To establish the incidence, type and significance of knee instability in patients with ipsilateral femoral and tibial shaft fracture, comparing with the patients with femoral shaft or tibial shaft fracture alone. MATERIALS AND METHODS: Two hundreds and seventy-nine consecutive patients were retrospectively reviewed from February 2000 to April 2004. They were composed of 80 patients with femoral shaft fracture alone, 176 patients with tibial shaft fracture alone and 23 patient with ipsilateral femoral and tibial shaft fracture. We evaluate the instability of knee based on physical examinations, plain stress films and MRI. We analyze incidence and period to diagnosis of instability, period to complete bony union and Hospital for Special Surgery (HSS) knee score respectively. RESULTS: There were 6.3% of knee instability in femoral shaft fracture alone, 9.7% in tibial shaft fracture alone and 30.4% in ipsilateral femoral and tibial shaft fracture. The average period to diagnosis of instability, average period to complete bony union and average HSS knee score were 9.2 months, 4.7 months and 65 points in femoral shaft fracture alone, 9.1 months, 4.2 months and 69 points in tibial shaft fracture alone, 8.7 months, 5.3 months (femur), 4.7 months (tibia) and 57 points in ipsilateral femoral and tibial shaft fracture respectively. CONCLUSION: We should consider MRI to evaluate the knee instability in patient with ipsilateral femoral and tibial shaft fracture at the time of injury and make a plan early about the treatment of knee instability.

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.

Ipsilateral Fractures of the Hip and Femoral Shaft / 대한정형외과학회잡지

Thirteen cases of concomitant hip and shaft fractures of the same femur are reported. The hip fractures was initially missed in one case. Osteosynthesis of both fractures was performed in twelve cases. One except was 12-year-old boy who was managed hip with two Knowles pins and shaft conservatively. Both fractures healed in all followed for average 5.3 months or more. Osteosynthesis of both fractures is recommended as soon as the patient is in a stable condition, preferably by early fixation with AO principle or IM nailing in selected cases.

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.

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

Thirty-three cases of the fracture of the femur and tibia on the same limb were treated at the Orthopedic Department of the Chosun University Hospital during the period from January 1977 to December 1983. The following results were obtained. 1. The incidence of trauma was high in the young man, most frequent in the third decade (45.4%). 2. The most common cause of the fracture was traffic accident (81;8%). 3. The most common shape of the fracture was comminuted in both femur and tibia. 4. The common fracture site were middle one-third in both femur and tibia. 5. Eight patients were treated by conservative means on both femxr and tibia. The patients were treated by internal fixation on femur and by conservative means on tibia. Internal fixation was .done in ten patients on both femur and tibia. Two patients were treated by inteinal fixation on tibia and by conservative means on femur. Three patients were amputated. 6. Average healing time of fracture was 21 weeks in femur and 24.2 weeks in tibia. 7. Functional end results were assessed and rated with satisfactory results in rigid internal fixation of the femur and tibia.

Clinical Study of Ipsilateral Femur and Tibia Fractures / 대한정형외과학회잡지

Twenty five cases of fractures of the femur & tibia on the same leg (floating knee) in 24 patients were treated in St. Mary's Hospital, Catholic Medical College and Center during the period 1977-1985. We studied all of these patients, divided by four groups according to the methods of treatment, retrospectively with analysis of treatment and end result. Our policy of treatment for these multiple fractures in single extremity was directed toward early weight bearing, active and passive knee exercise by early open reduction and rigid internal fixation for both fractures. The results obtained were as follows: l. Of 25 cases, 20 patients were male and 5 were female. 2. The right lower extremity has constituted 56% of the cases. 3. Average age of patients were 37 years. 4. Most common level of fractures was on middle one third of femur (71.4% ) and proximal one third of tibia (46.2%). Of these 25 cases, three cases of femur and one case of tibia were segmental fractures, and one case of femur and five cases of tibia were open fractures initially. 5. Of 28 cases of femur fracture, 23 were given operative treatment and five conservative method. But out of 26 cases of tibia fracture, each half cases of fracture were treated operatively and conservatively. 6. We analysed the final results of treatment by the time of fracture union roentgenologically and five lower limb functions clinically at the termination of treatment. The average time for fracture union was 20.5 weeks for femur and 21.9 weeks for tibia roentgenologically. The acceptable clinical results could be achieved in 18 cases (72%) of early open reduction and rigid internal fixation for both tibia and femur as early as possible after accident for early knee exercises. 7. The status of fractured tibia was the most important factor to treat these multiple fractures in single extremity because of troublesome to start knee exercise and weight bearing.

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.