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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2026, Number 4

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Acta Ortop Mex 2026; 40 (4)

Functional outcomes of treatment in pediatric patients with floating knee injury: case series

Ruíz-Mejía O, Sosa-Arias J, Casas-López M

Language: Spanish
References: 33
Page: 248-253
PDF size: 1002.71 Kb.


ABSTRACT

Introduction: f loating knee in the pediatric population is an uncommon but severe injury, typically resulting from highenergy mechanisms, and it significantly impacts the patient’s functional outcome. Objective: to evaluate the functional outcomes of pediatric patients with floating knee injuries treated at our hospital. Material and methods: this is a retrospective, observational, crosssectional study conducted at UMAE HTYOLV from March 2018 to March 2025, using nonprobabilistic convenience sampling and statistical analysis with the χ2. Results: twelve patients with floating knee injury were included; 83.33% were male, with a mean age of 14 years, and predominance of the left lower limb (58.3%). Injuries were caused by highenergy mechanisms, predominantly motorcycle accidents (66.67%). According to the LettsVincent classification, the distribution was: Type A (n = 4, 33.3%), Type D (n = 4, 33.3%), and Type E (n = 3, 25%). Patients required an average of 2.75 surgical interventions. Functional outcomes assessed with the Karlstrom and Olerud scale were rated as poor in 33.3%, good in 25%, and acceptable in 16.67%. Six patients developed complications, the most frequent being pseudoarthrosis of one of the affected bones (n = 3, 25%). The most severe complication was osteomyelitis (n = 1, 8.33%), which required transfemoral amputation. Conclusion: floating knee in pediatric patients is a lowprevalence condition resulting from highenergy trauma, causing severe injuries and sequelae that compromise patient functionality. Surgical management is recommended in all cases.


REFERENCES

  1. Fraser RD, Hunter GA, Waddell JP. Ipsilateral fracture of the femurand tibia. J Bone Joint Surg Br. 1978; 60-B(4): 510-5.

  2. Blake R, McBryde A. The floating knee: Ipsilateral fractures of thetibia and femur. South Med J. 1975; 68(1): 13-6.

  3. Dwyer AJ, Paul R, Mam MK, Kumar A, Gosselin RA. Floating kneeinjuries: long-termresults of four treatment methods. Int Orthop. 2005;29(5): 314-8.

  4. Alqami MM, Alaskari AA, Al Zomia AS, et al. Epidemiology andpattern of orthopedic trauma in children and adolescents: implicationsfor injury prevention. Cureus. 2023; 15(5): e39482.

  5. Yadav S, Rawal G. Advances in understanding and managing floatingknee injuries: a comprehensive review. Cureus. 2024; 16(3): e57122.

  6. CORTICES. The pediatric “floating knee” injury: a state-of-the-artmulticenter study. J Bone Joint Surg Am. 2019; 101(19): 1761-1767.

  7. Mohamed SO, Ju W, Qin Y, Qi B. The term “floating” used intraumatic orthopedics. Medicine (Baltimore). 2019; 98(7): e14497.

  8. Card RK, Lowe JB, Mabrouk A, Bokhari AA. Floating Knee. 2024.In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2026.

  9. Saini G, Sen RK, Kalia A, Kadam S. Implant-associated Hoffa’sfracture in a floating knee: a case report and review of literature. JOrthop Case Rep. 2019; 9(3): 79-83.

  10. Vallier HA, Manzano GW. Management of the floating knee:ipsilateral fractures of the femur and tibia. J Am Acad Orthop Surg.2020; 28(2): e47-e54.

  11. Wang J, Luo L, Zhao Z, Huang B. Floating knee with rupture ofpopliteal artery: a case report and literature review. Asian J Surg.2023; 46(9): 4038-4039.

  12. Alencar JB, Lira RCA, Cavalcante RDS, Lopes MBG, Sousa CJD,Lima DA. Incidence of deep vein thrombosis in floating knee. ActaOrtop Bras. 2021; 29(1): 17-20.

  13. Tomar L, Govil G, Dhawan P. Bilateral periprosthetic knee fracturewith the right floating total knee and left periprosthetic patella fracturemanagement strategy: a case report. J Orthop Case Rep. 2021; 11(2): 1-5.

  14. Ethiraj P, Shringeri AS, Prasad PA, Shanthappa AH, Nagarajan V.Early total care versus damage control orthopedics in floating kneeinjury: analysis of radiological and functional outcomes. Cureus.2022; 14(6): e25615.

  15. Zhang MR, Zhao K, Chen HY, Guo JL. Intramedullary nailing forfloating knee injurycomplicated by pulmonary fat embolism: A casereport and literature review. Trauma Case Rep. 2024; 52: 101040.

  16. Rollo G, Falzarano G, Ronga M, Bisaccia M, Grubor P, Erasmo R, etal. Challenges in the management of floating knee injuries: results oftreatment and outcomes of 224 consecutive cases in 10 years. Injury.2019; 50 Suppl 4: S30-8.

  17. Alencar-Neto JB, Osório-Neto EB, Souza CJD, da Rocha PHM,Cavalcante MLC, Lopes MBG. Evaluation of the Interobserveragreement of the Fraser and Blake & McBryde classifications forfloating knee. Rev Bras Ortop (Sao Paulo). 2021; 56(4): 459-462.

  18. Karslı B, Tekin SB. The floating knee injuries: does it need a newclassification system? Indian J Orthop. 2020; 55(2): 499-505.

  19. Chouhan D, Chouhan DK, Kanojia RK, Behera P. Comparison offunctional outcomes amongsubtypes of Fraser’s type Ⅱ floating knee.Chin J Traumatol. 2021; 24(1): 25-29.

  20. Kar S, Sugumar PAA, Sharma V, Farooque K, JanardhananR, Jeyaraman M. Bilateral floating knee injuries managed byintramedullary nailing - An unusual injury. J Orthop Case Rep. 2024;14(2): 29-33.

  21. Espinosa KA, Gómez-Gélvez A, Torres LP, Peña OR. Rodilla flotante:modificación de la clasificación de Fraser y factores asociados conlos resultados funcionales. Rev Colomb Ortop Traumatol. 2020;56(2012): 42-46.

  22. Kenmegne GR, Zou C, Lin Y, Yin Y, Huang S, Fang Y. The currentissues and challengesin the management of floating knee injury: aretrospective study. Front Surg. 2023; 10: 1164032.

  23. Shukla R, Jain A, Jain RK. Long-term study of functional outcomes offloating knee injuries. J Orthop Traumatol Rehab. 2020; 12(1): p23-30.

  24. Bozgeyik B, Buyukbebeci O, Guner S, Mert A. Comparative analysisof open and closed floating knee injuries. Acta Ortop Bras. 2023;31(4): e262810.

  25. Navarro-Vergara AD, Fretes AN. The floating knee in pediatricpatients: a single-center retrospective study from a referral center.Cureus. 2022; 14(9): e29517.

  26. Yue JJ, Churchill RS, Cooperman DR, Yasko AW, Wilber JH,Thompson GH. The floating knee in the pediatric patient.Nonoperative versus operative stabilization. Clin Orthop Relat Res.2000; 376: 124-36.

  27. Letts M Vincent N. Gouw G. The floating knee in children. J BoneJoint Surg, 1986; 68(3): 442-6.

  28. Tontanahal S, James D, Gahukamble A, Madhuri V, Palocaren T.Pediatric floating knee injuries: clinical modifiers affecting sports andtransfer outcomes. Injury. 2023; 54(11): 111001.

  29. Jafari Kafiabadi M, Sadighi M, Sabaghzadeh A, Biglari F, Rad SB,Ebranhimpour A. Bilateral floating knee injuriesinan infant: a casereport and literature review. J Orthop Spine Trauma. 2021; 7(3): 120-2.

  30. Anari JB, Neuwirth AL, Horn BD, Baldwin KD. Ipsilateral femurand tibia fracturesinpediatric patients: a systematic review. World JOrthop. 2017; 8(8): 638-43.

  31. Ochoa-Olvera L, Perez-Salazar-Marina D, Rabagui Richeran A,Domínguez BCA. Rodilla flotante, evaluación funcional en pacientessometidos a osteosíntesis. An Med (Mex). 2012; 57(4): 292-299.

  32. Othman Y, Hassini L, Fekih A, Aloui I, Abid A. Uncommon floatingknee in a teenager: a case report of ipsilateral physeal fractures indistal femur and proximal tibia. J Orthop Case Rep. 2017; 7(2): 90-93.

  33. Ng A, Morley JR, Prasad RN, Giannoudis PV, Smith RM. Thepaediatric floating knee: a case report of ipsilateral epiphyseal injuryto the distal femur and proximal tibia. J Pediatr Orthop B. 2004;13(2): 110-3.




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