Floating Knee: Combined Femoral and Tibial Fractures

Abstract

Ipsilateral femur and tibial shaft fractures are uncommon in the pediatric population and frequently result from high-energy mechanisms of injury. These floating knee injuries often add significant complexity to fracture management. Many are associated with concommitant visceral, thoracic, and/or head injuries that may take precedence over definitive fracture fixation especially in the setting of hemodynamic instability. Furthermore, orthopaedic surgeons must often alter implant selection, patient postioning, and choice of operative table from one’s usual practice when managing either fracture in isolation. This case highlights the management strategies of a 10-year-old male involved in a high velocity trauma who sustained a femoral neck fracture, an ipsilateral open distal third femoral shaft fracture, and an ipsilateral fracture of the tibial diaphysis. We present a management strategy to maximize fixation efficiency though reduction techniques and implant choices while addressing the specific complexities of each fracture.