Imaging Studies
Imaging modalities that may be helpful include plain radiography, magnetic resonance imaging (MRI), and computed tomography (CT).
Obtain anteroposterior (AP) and lateral radiographs of the femur and tibia, including views of the joint above and below. Order radiographs showing the pelvis and both hips. Obtain AP and lateral views of the affected knee.
MRI of the knee joint is advocated in patients with suspected injuries to the intra- or extra-articular ligaments. MRI findings may in help in planning management of ligamentous injuries.
CT scans of the metaphyseal fractures may be useful for understanding the three-dimensional configuration of the fracture fragments.
In addition, generalized radiologic screening of suspected skeletal injuries may be undertaken.
None of the investigations should hinder surgical management in emergency situations. In these circumstances, intraoperative examination under anesthesia after stabilization of the fractures may be more appropriate.
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Fraser classification of floating knee injuries.
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Karlstrom and Olerud's criteria for assessing functional outcomes after a floating knee injury.
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Letts and Vincent classification system for floating knee injuries in children.
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Treatment protocol for floating knee injuries. Ex-Fix = external fixation; IM = intramedullary; ORIF = open reduction and internal fixation.
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Floating knee injury.
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Positioning for surgery to treat a floating knee injury.
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Conservative management of the femur in an ipsilateral injury of this type is likely to result in malunion of the femoral fracture and shortening.
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Early joint mobilization determines the patient's functional outcome after treatment of floating knee injuries. Nailing of both the tibial and the femoral fractures, as shown, is the best method for enabling early mobilization.
