Skip to main content
SpringerLink
Log in

Heterotopic ossification around the knee after tibial nailing and ipsilateral antegrade and retrograde femoral nailing in the treatment of floating knee injuries

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Floating knee injuries are relatively uncommon injuries. We report the prevalence, location, and severity of heterotopic ossification (HO) around the knee in patients treated with antegrade tibial intramedullary nailing and ipsilateral antegrade versus retrograde femoral intramedullary nailing as well as how the severity of HO around the knee affects knee range of motion (ROM).

Methods

From 2004 to 2014, 26 floating knee injuries were included. Radiographs were reviewed to determine presence, location, and severity of HO. Post-operative knee ROM was determined.

Results

A significantly higher prevalence of HO around the knee was detected in the retrograde group (90%) compared to the antegrade group (43%) (p = 0.028). There was a trend for more HO into the patellar tendon occurring in 29% of patients in the antegrade group and 74% in the retrograde group (p = 0.069). The severity of HO was higher for the retrograde group 1.6 ± 1.0 compared to the antegrade group 0.4 ± 0.5 (p = 0.004). There was poor correlation between HO severity and knee ROM.

Conclusions

Treatment of floating knee injuries with a retrograde femoral nail was demonstrated to result in a greater likelihood of developing HO and a greater severity of HO around the knee than if treated with an antegrade femoral nail. However, this increased severity of HO is unlikely to affect ROM.

Level of evidence: III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Elmrini A, Elibrahimi A, Agoumi O, Boutayeb F, Mahfoud M, Elbardouni A, Elyaacoubi M (2006) Ipsilateral fractures of tibia and femur or floating knee. Int Orthop 30(5):325–328. https://doi.org/10.1007/s00264-006-0084-0

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Nouraei MH, Hosseini A, Zarezadeh A, Zahiri M (2013) Floating knee injuries: results of treatment and outcomes. J Res Med Sci 18(12):1087–1091

    PubMed  PubMed Central  Google Scholar 

  3. Fraser RD, Hunter GA, Waddell JP (1978) Ipsilateral fracture of the femur and tibia. J Bone Joint Surg Br 60-B(4):510–515

    Article  PubMed  CAS  Google Scholar 

  4. Omer GE Jr, Moll JH, Bacon WL (1968) Combinded fractures of the femur and tibia in a single extremity. Analytical study of cases at Brooke General Hospital from 1961-to1967. J Trauma 8(6):1026–1041

    Article  PubMed  Google Scholar 

  5. Paul GR, Sawka MW, Whitelaw GP (1990) Fractures of the ipsilateral femur and tibia: emphasis on intra-articular and soft tissue injury. J Orthop Trauma 4(3):309–314

    Article  PubMed  CAS  Google Scholar 

  6. Kaplan FS, Glaser DL, Hebela N, Shore EM (2004) Heterotopic ossification. J Am Acad Orthop Surg 12(2):116–125

    Article  PubMed  Google Scholar 

  7. Mitchell EJ, Canter J, Norris P, Jenkins J, Morris J (2010) The genetics of heterotopic ossification: insight into the bone remodeling pathway. J Orthop Trauma 24(9):530–533. https://doi.org/10.1097/BOT.0b013e3181ed147b

    Article  PubMed  Google Scholar 

  8. Nauth A, Giles E, Potter BK, Nesti LJ, O’Brien FP, Bosse MJ, Anglen JO, Mehta S, Ahn J, Miclau T, Schemitsch EH (2012) Heterotopic ossification in orthopaedic trauma. J Orthop Trauma 26(12):684–688. https://doi.org/10.1097/BOT.0b013e3182724624

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shehab D, Elgazzar AH, Collier BD (2002) Heterotopic ossification. J Nucl Med 43(3):346–353

    PubMed  Google Scholar 

  10. Cipriano CA, Pill SG, Keenan MA (2009) Heterotopic ossification following traumatic brain injury and spinal cord injury. J Am Acad Orthop Surg 17(11):689–697

    Article  PubMed  Google Scholar 

  11. Forsberg JA, Pepek JM, Wagner S, Wilson K, Flint J, Andersen RC, Tadaki D, Gage FA, Stojadinovic A, Elster EA (2009) Heterotopic ossification in high-energy wartime extremity injuries: prevalence and risk factors. J Bone Joint Surg Am 91(5):1084–1091. https://doi.org/10.2106/JBJS.H.00792

    Article  PubMed  Google Scholar 

  12. Garland DE (1988) Clinical observations on fractures and heterotopic ossification in the spinal cord and traumatic brain injured populations. Clin Orthop Relat Res 233:86–101

    Google Scholar 

  13. Wittenberg RH, Peschke U, Botel U (1992) Heterotopic ossification after spinal cord injury. Epidemiology and risk factors. J Bone Joint Surg Br 74(2):215–218

    Article  PubMed  CAS  Google Scholar 

  14. Mills WJ, Tejwani N (2003) Heterotopic ossification after knee dislocation: the predictive value of the injury severity score. J Orthop Trauma 17(5):338–345

    Article  PubMed  Google Scholar 

  15. Stannard JP, Wilson TC, Sheils TM, McGwin G Jr, Volgas DA, Alonso JE (2002) Heterotopic ossification associated with knee dislocation. Arthroscopy 18(8):835–839

    Article  PubMed  Google Scholar 

  16. Horne LT, Blue BA (1999) Intraarticular heterotopic ossification in the knee following intramedullary nailing of the fractured femur using a retrograde method. J Orthop Trauma 13(5):385–388

    Article  PubMed  CAS  Google Scholar 

  17. Howell RD, Park JH, Egol KA (2011) Late symptomatic heterotopic ossification of the patellar tendon after medial parapatellar intramedullary nailing of the tibia. Orthopedics 34(3):226. https://doi.org/10.3928/01477447-20110124-32

    Article  PubMed  Google Scholar 

  18. Takemoto RC, Epstein D, McLaurin TM (2011) Intra- and periarticular heterotopic ossification in the knee after a low-velocity gunshot wound treated with retrograde intramedullary nailing of the femur. J Orthop Trauma 25(7):e77–e82. https://doi.org/10.1097/BOT.0b013e3181f981e1

    Article  PubMed  Google Scholar 

  19. Lundy DW, Johnson KD (2001) “Floating knee” injuries: ipsilateral fractures of the femur and tibia. J Am Acad Orthop Surg 9(4):238–245

    Article  PubMed  CAS  Google Scholar 

  20. Simonsen LL, Sonne-Holm S, Krasheninnikoff M, Engberg AW (2007) Symptomatic heterotopic ossification after very severe traumatic brain injury in 114 patients: incidence and risk factors. Injury 38(10):1146–1150. https://doi.org/10.1016/j.injury.2007.03.019

    Article  PubMed  Google Scholar 

  21. Gosselin RA, Belzer JP, Contreras DM (1993) Heterotopic ossification of the patellar tendon following intramedullary nailing of the tibia: report on two cases. J Trauma 34(1):161–163

    Article  PubMed  CAS  Google Scholar 

  22. Tornetta P 3rd, Tiburzi D (2000) Antegrade or retrograde reamed femoral nailing. A prospective, randomised trial. J Bone Joint Surg Br 82(5):652–654

    Article  PubMed  Google Scholar 

  23. Ricci WM, Bellabarba C, Evanoff B, Herscovici D, DiPasquale T, Sanders R (2001) Retrograde versus antegrade nailing of femoral shaft fractures. J Orthop Trauma 15(3):161–169

    Article  PubMed  CAS  Google Scholar 

  24. Kuhn KM, Ali A, Boudreau JA, Cannada LK, Watson JT (2013) Antegrade versus retrograde intramedullary nailing of proximal third femur fractures. J Surg Orthop Adv 22(4):263–269

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, UC San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA

    William T. Kent

  2. Department of Orthopaedics, UC Davis, University of California, Davis, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA

    Trevor J. Shelton & Jonathan Eastman

Authors
  1. William T. Kent
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Trevor J. Shelton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathan Eastman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Trevor J. Shelton.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Patient consent

Obtaining the informed consent from involved patients was waived by the Institutional Review Board.

Ethical approval

All procedures involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments. The study was approved by the Institutional Review Board.

The study was approved by our ethical committee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kent, W.T., Shelton, T.J. & Eastman, J. Heterotopic ossification around the knee after tibial nailing and ipsilateral antegrade and retrograde femoral nailing in the treatment of floating knee injuries. International Orthopaedics (SICOT) 42, 1379–1385 (2018). https://doi.org/10.1007/s00264-018-3845-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-018-3845-7

Keywords

Search

Navigation