ipsilateral femur and tibia fracture

2011 Jun [PubMed PMID: 21629474] Carta S,Riva A,Fortina M,Colasanti GB,Meccariello L, The Challenges of the Femoral Bone Loss in the Management of the Floating Knee IIB According Fraser: … Figure 5. We found that the lateral articular edge of the tibia was slightly lateral to the lateral articular edge of the femur (mean dLA, 0.9±1 mm). Once the patient's airway, breathing, and However, there was a numerical imbalance, although nonsignificant, in some AEs. More than half (52) of the patients were treated non-operatively for both fractures. The results show that the contralateral tibial plateau and the ipsilateral distal femur might conceivably be used as references for tibial plateau fracture reduction. Karlström G, Olerud S. Ipsilateral fracture of the femur and tibia. This is an isolated fracture of the tibia with an intact fibula. advantages . In five patients with ipsilateral femoral and tibial shaft fractures the Hoffmann apparatus was used to stabilize the fractures of both the femur and tibia. with ipsilateral fracture of distal femur or proximal tibia. It’s the most common tibial shaft fracture. A Thomas splint has already been applied. View This Abstract Online; Ipsilateral fracture of the femur and tibia. The fractures range from simple diaphyseal to complex articular types. Ipsilateral fracture of femur and tibia includes a combination of diaphyseal, metaphyseal and intra articular fractures. A report of fifty-seven consecutive cases. Treatment includes setting the bone without surgery and a long-leg cast with the knee bent. The plateau is a critical weight-bearing area consisting of the medial and lateral condyles and the intercondylar ridge between. Periprosthetic fracture 9. He was taken to a local hospital and radiographic examination revealed a right-sided (open) complex distal femur fracture with bone loss and ipsilateral (open) mid-shaft tibia and fibula fracture. These are extremely heterogeneous groups of injuries. The combination of femoral shaft and tibial shaft fractures on the same side, producing a ‘floating knee’, signals a high risk of multi-system injury in the patient. These injuries can cause serious morbidity or mortality due to the high incidence of the associated injuries and complications,,,. Ipsilateral fibular strut graft was used to fill the lateral distal femur void with 3.5 mm cortical screws. Diagnosis is made radiographically with radiographs of the femur as well as the hip to rule out ipsilateral femoral neck fractures. Treatment of ipsilateral femur and tibia fractures. 5 Readers. Both the isolated distal femoral epiphysiolysis and the isolated proximal tibial epiphysiolysis are the least common epiphyseal injuries. Fourteen (67%) of the 21 patients sustained a total of 17 open fractures (76% of which were grade II or III wounds). Impaction bone-grafting in the treatment of a periprosthetic fracture of the tibia: a case report. They are caused by high-velocity accidents and are often combined with extensive soft-tissue trauma and injuries to other systems. The associated injuries with Hoffa’s fracture are in the ipsilateral distal femur, proximal tibia fractures, patellar dislocation, patella fracture, and patellar tendon incarceration. J Bone Joint Surg Am. Thirty-five per cent of patients required late operation for delayed union or non-union, osteomyelitis, refracture and malunion, regardless of the treatment group. Thirty-two cases of simultaneous ipsilateral femoral and tibial fractures in thirty-one patients were treated by rigid internal or pin fixation of both fractures in fourteen cases, by rigid internal or pin fixation of one fracture in three, and by conservative management or non-rigid internal fixation in fifteen. Ipsilateral femur / tibia fractures The patient is complaining of pain in his right thigh, which appears to be swollen and deformed. J Orthop Trauma 1990;4:309–314. The hospital records of 222 cases of ipsilateral fractures of the femur and tibia were reviewed, and patients were grouped according to the type of fracture and the method of treatment. If the degree of fracture does not match the mechanism of injury then a pathologic fracture must be suspected (2). Summary. Expeditious fracture reduction and patient resuscitation are crucial, while type and timing of provisional and definitive management is guided by the extent of injury … Ipsilateral fractures of the femur and tibia: treatment with retrograde femoral nailing and unreamed tibial nailing. Secondary objective of the study was to identify factors affecting the eventual functional outcome of ipsilateral tibia and femur fracture. Fracture with vascular injury (Gustillo Type IIIC injury) requiring repair 5. DeLee J; Clinical orthopaedics and related research (1979) (142) 115-122. He was treated with operative fixation, and was walking without assistive devices at his most recent follow-up appointment in February 2019. Twenty-one patients with fractures of the ipsilateral femur and tibia were treated at Boston City Hospital from 1982 through 1987. All were caused by road accidents. J Bone Joint Surg Br. Abstract. The term describes an injury pattern of ipsilateral fracture of tibia and femoral shaft. The aim of our study is to evaluate clinical, functional and radiological outcomes of these injuries, managed surgically. We present a case with Gustilo-Anderson grade 3b open and Salter-Harris type 1 epiphysiolysis of the distal femur and proximal tibia caused by a farm machinery accident. 14 cases of ipsilateral fractures of the femur and tibia were reviewed from the hospital records. FRACTURE SHAFT OF FEMUR Presented by Prakat c. Aryal Intern Orthopedics Group N 2/3/2018 P.C.Aryal Intern Group N 1 2. J Bone Joint Surg Am 1984;66:991–1002. A floating knee may compromise limb viability due to severe soft-tissue and vascular injury. The pin track became infected in three patients. fixator is locked in slight flexion. Rigid internal or pin fixation of both fractures resulted in a lower incidence of complications and … eau and the ipsilateral distal femur might conceivably be used as references for tibial plateau fracture reduction. Material and Methods: 8 patients (6 male and 2 female) with ipsilateral intertrochancteric and shaft of femur fractures were treated with various fixation devices. Abstract. These are relatively uncommon injuries. Management of … 8. Even though they are uncommon, they have a high incidence rate of complications. Sohn SK, Kim KT, Kim BY, Jung BH, Hwang KS. The management of the fractures was partially the same. they were classified according to Fraser's classification into type I (8 cases), IIa (3 cases), IIb (1 case), IIc (1 case). Treatment recommendations have varied for ipsilateral femoral and tibial fractures. Fractures of the ipsilateral femur and tibia has variable results depending on modes of treatment. The open wounds were irrigated and debrided on multiple occasions. Ipsilateral fractures of the femur and tibia have been called “floating knee” injuries and may include combinations of diaphyseal, metaphyseal, and intra-articular fractures. Methodology: The study included 15 patients aged 20 to 60. If the address matches an existing account you will receive an email with instructions to retrieve your username The "floating knee" is defined as fractures of the ipsilateral femur and tibia, which consists of a spectrum of injury, and may be in isolation or part of multiple system trauma for a given patient. Case Presentation A 16-year old boy was presented with swelling and pain in the right knee joint. What is the orthopaedic management of this patient in the ER? Adult ipsilateral femur and tibia fractures (floating knee) are rare injuries that occur as a result of high-energy trauma. 14 cases of ipsilateral fractures of the femur and tibia were reviewed from the hospital records. The hip dislocation was reduced under general anaesthesia with a closed procedure. Shock due to blood loss from the fracture as femur fractures can cause 1-1,5l of blood loss or secondary blood loss due to other associated injuries since femur fractures are caused by high energy trauma (associated with ipsilateral tibia and pelvic fractures). Abstract. The pin track became infected in three patients. All were caused by road accidents. Pathological fracture 6. Patients with ipsilateral femoral and tibial fractures have often suffered polytrauma and therefore may have significant injuries of other organ systems. They tend to be among the more seriously injured trauma patients and have a higher incidence of associated injuries than patients with isolated femoral or tibial fractures. Aim and objective of study was to assess functional outcome of surgical management of patients having ipsilateral tibia and femur fracture using Karlstrom and Oleruds criteria. Unstable displaced fractures may require surgery. Patients presenting with floating knee injuries from the year 2011 to 2014 were included in the study. Bohn and Durbin 10 reported no rotational malalignment in 30 children (32 limbs) with ipsilateral femoral and tibial fractures monitored for a mean of 5.1 years. DOI: 10.1097/00003086-197907000-00019. Ipsilateral fractures of the femur and tibia, or floating knee, are major injuries occurring frequently among an active population. The study was conducted to evaluate the results of surgery for adults with ipsilateral femoral and tibial fractures. A tibial plateau fracture occurs in the proximal part of the tibia involving the joint affecting the knee joint, stability, alignment and motion. They usually occur due to high energy trauma like road traffic accidents. They often result from a high-energy mechanism of injury. Background: Due to the large number of accidents, femur and tibia for Ipsilateral injuries eventually occur; floating injuries are likely to take place. Fractures in the distal segment of the femur are particularly prone to the … Many of these fractures are open, with associated vascular injuries. The literature currently available to the practicing orthopaedic surgeon is of limited value given the historic nature of the studies and available treatment strategies at the time of investigation. The two commonest patterns were fractures of the shafts of the femur and tibia and fractures of the shaft of the femur and the tibial condyle. The aim of the study was a retrospective evaluation of the surgical treatment of 171 fractures of the proximal femur and the femoral shaft. Ipsilateral fracture of the femur and tibia treated in a quadrilateral cast brace. Ipsilateral fractures of the femur and tibia in the adult, or floating knee injury, is a complex lesion with more than just ipsilateral fractures of the femur and tibia. When both fractures are diaphyseal the injury is classified as type 1 [1] . Management: Resuscitate with … J … Immediate skeletal traction was applied to the ipsilateral tibia to prevent further displacement of the fracture and damage to the blood supply of the femoral head. Rigid internal fixation of both the femur and the tibia in case of fracture through the shaft of both bones gave satisfactory functional end result. underwent temporary epiphysiodesis at the distal femur and/ or proximal tibia from 2010 to 2017 (minimum two years fol-low-up). Abstract and Figures This is a retrospective study of 18 patients who had ipsilateral femoral and tibial fractures. 1986 May. 1977; 59(2):240-3 (ISSN: 0021-9355). Yue and associates 113 reported one malrotation in 16 patients with ipsilateral femoral and tibial fractures treated nonoperatively and none in the 13 patients (14 extremities) treated by operative stabilization. Lodox image of a patient with a diaphyseal femur and ipsilateral tibia fracture. Between the years 1994 and 2008, 171 ipsilateral fractures were operatively treated in 169 patients with an 1. The management of the fractures was partially the same. Six patients had open fracture. 1978 Nov. 60-B (4):510-5. . Ipsilateral distal femur metaphyseal fracture with or without intercondylar extension 4. Thirty-two cases of simultaneous ipsilateral femoral and tibial fractures in thirty-one patients were treated by rigid internal or pin fixation of both fractures in fourteen cases, by rigid internal or pin fixation of one fracture in three, and by conservative management or non-rigid internal fixation in fifteen. We report a series of 18 ipsilateral fractures of the femur and the tibia treated at the Department of orthopaedics, CHU Hassan II … Twenty-one patients with fractures of the ipsilateral femur and tibia were treated at Boston City Hospital from 1982 through 1987. Abstract Associated ipsilateral femoral neck fractures have been reported to occur in 1% to 9% of femoral shaft fractures. 2. Ipsilateral fractures of the femur and the tibia are relatively uncommon lesions, with critical consequences to the knee. - consider retrograde nailing of the femoral shaft, so that the same incision can be used to nail the tibia; The "floating knee" in children. An ipsilateral femoral neck fracture occurs in about 10 per cent of cases and, if present, there is a one in three chance of a significant knee injury as well. Objective: The aim of this study was to report our experience on concomitant ipsilateral proximal tibia and femoral Hoffa fractures. findings. Two patients had ipsilateral femoral shaft fracture, two patients had fracture of intercondylar part of distal femur, one had fracture of patella and one had fracture of both bones of the leg. Although earlier reports favoured non-operative treatment, poor results, such as non-union or malunion, have been reported with such treatment [8, 18].Aggressive, early stabilisation of both fractures is important to prevent systemic complications in polytrauma patients, such as a floating-knee injury [3, 8, 10]. Ipsilateral fractures of the femur and tibia result in a flail joint described as 'floating knee'. When the ipsilateral tibia and femur are fractured, the incidence of open fractures is higher than with an isolated fracture of either bone. It is most common for there to be an open tibial fracture and a closed femoral fracture. There were 20 men and 12 women with a mean age of 27 years (range 18–75 years). 3. Hence, they are frequently associated with other concomitant injuries to the ipsilateral limb or other parts of body of which injury to the ipsilateral knee ligaments carries significance for various reasons. Letts M, Vincent N, Gouw G. The "floating knee" in children. Recon E 12509 12962243 Henry SL., AJO 2002. Fracture of the Femoral Shaft with Ipsilateral Fracture of the Femoral neck 박희곤ㆍ김명호ㆍ유문집ㆍ유현열ㆍ이대희 Dept. . Veith RG, Winquist RA, Hansen ST. Ipsilateral fractures of the femur and tibia. The trauma series radiographs of the knee joint with anteroposterior, lateral, oblique, and … Ipsilateral fractures of the femur and tibia. From October 1987 to September 1990, 32 patients with ipsilateral fractures of the femur and the tibia were treated. allows soft tissue swelling to decrease before definitive fixation. The word floating knee was coined for the of tibial Gustilo type III open fractures where wound care first time by McBryde in 1965 [3, 4]. General E 12510 20686933 Lee GC, CORR 2011. Patient was initially taken for surgery where debridement of compound wound over femur and stabilisation with external fixator for femur was done along with stabilisation with posterior POP slab for tibia and distal femur fracture. Materials and Methods Multiple established indications for retrograde femoral nailing include but are not limited to ipsilateral femoral neck fractures identified prior to nailing, ipsilateral tibia fracture (“floating knee” injuries), ipsilateral acetabulum fractures, bilateral femur fractures, morbid obesity, and pregnancy. Over 75% of the fractures of both the tibia and the femur involved the diaphysis. In conclusion, concomitant ipsilateral rupture of quadriceps tendon, closed oblique fracture of the distal tibia, and supination external rotation ankle injuries are rare and to the best of our knowledge have not been extensively reported. There were 20 men and 12 women with a mean age of 27 years (range 18-75 years). Ipsilateral fracture of the femur and tibia. Fracture shaft of femur 1. The two commonest patterns were fractures of the shafts of the femur and tibia and fractures of the shaft of the femur and the tibial condyle. Rigid internal fixation of both the femur and the tibia in case of fracture through the shaft of both bones gave satisfactory functional end result. Ipsilateral fracture of the femur and tibia have been called 'floating knee' injuries and may include conbination of diaphyseal, metaphyseal & intra-articular fractures (1,2). The posterior surface of patella was freshened and fixed to the tibia and femur using 4 mm cannulated cancellous screws (Figures 5A- -5D 5D). Using the criteria for assessment described by Karlstrom, cases were graded as excellent, good, acceptable and poor. Femur fracture, floating knee, intramedullary nailing, single knee incision, tibia fracture. From October 1987 to September 1990, 32 patients with ipsilateral fractures of the femur and the tibia were treated. Summary Between 1989 and 1995 a total of 47 patients with 50 fractures of the ipsilateral femoral and tibial shafts without significant articular involvement were treated at Tampa General Hospital. Ipsilateral proximal femur, tibia or ankle • Open injuries occur in 5-10% Early administration of antibiotics with a thorough debridement and irrigation is of utmost importance Transfer to definitive tertiary care center Temporizing with external fixation may be necessary . Ipsilateral fractures of the femur and tibia. Ipsilateral fractures of the tibia and femur are rare but severe injuries in children and adolescents. Many of these fractures are open, with associated vascular injuries. Surgical outcome of ipsilateral fracture of the femur and tibia in adults (floating knee) Tumbal SV1, Kothadia S2 1 ... Background: Due to the large number of accidents, femur and tibia for Ipsilateral injuries eventually occur; floating injuries are likely to take place. An x-ray reveals a mid-shaft Femur Fracture. These are always associated with high morbidity. Efficacy of decreasing LLD was assessed one and two years postoperatively. Tibial open grade III fractures were fixed first by external fixation. Beharrie AW, Nelson CL. Methods: Nine patients (8 male, 1 female; mean age: 30.9; range: 19-49 years) presented to our emergency room with an ipsilateral proximal tibia and femoral Hoffa fracture, following road traffic accident. Ipsilateral fracture of the femur and tibia treated in a quadrilateral cast brace. From October 1987 to September 1990, 32 patients with ipsilateral fractures of the femur and the tibia were treated. J … Femoral shaft fractures are high energy injuries to the femur that are associated with life-threatening injuries (pulmonary, cerebral) and ipsilateral femoral neck fractures. The injury is usually in association with the multiple injury patient involved in a high velocity trauma event. This suggests that attempting to reduce the lateral tibial condylar or articular edges to Anterolateral rotatory instability was the most common instability pattern. These findings suggest that ipsilateral femoral and tibial fractures do not provide a protective effect to the knee ligaments, and the higher incidence of knee ligament injuries is demonstrative of the significant force that these patients have sustained. Learning objectives . The osteosynthesis Ipsilateral fractures of the femur and tibia are relatively of the femur should be performed first with the exception uncommon [2]. Recon L 3 C PDF: 12511 12690863 Cain EL Jr 2003. Complications were classified with the modified Clavien-Dindo-Sink complication classification system. Signs of fat embolus syndrome. However, the combination of vertical sagittal fracture patella with fracture ipsilateral lateral femoral condyle is very rare and is being presented in this case report. Ipsilateral fractures of the femur and tibia have been called "floating knee" injuries and may include combinations of diaphyseal, metaphyseal, and intra-articular fractures. Floating Knee is the term applied to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur and tibia . 68 (3):442-6. . "Floating total knee": ipsilateral periprosthetic fractures of the distal femur and proximal tibia after total knee arthroplasty. Yirmi dırt olguda ipsilateral femur ve tibia kÝrÝÛÝ. These are often high-energy injuries and most frequently occur in the polytrauma patient. It is caused by a rotational or twisting force such as a sports injury or a fall. There were 7 femoral and 22 tibial open fractures. Ipsilateral fracture of the femur and tibia. Abstract: Fractures of the ipsilateral femur and tibia has variable results depending on modes of treatment. Hegazy AM, Surgical management of ipsilateral fracture of the femur and tibia in adults (the floating knee): postoperative clinical, radiological, and functional outcomes. Thirteen cases of ipsilateral fractures of the femur and tibia were treated. Known metabolic bone disease 7. Fracture of the ipsilateral femur and tibia: emphasis on intra-articular and soft tissue injury. Erißkinlerde Òfloating kneeÓ The floating knee in adults. ipsilateral pelvic disruption, hip dislocation, a femoral shaft fracture, supra and intercondylar fracture of the femur, and tibial shaft fracture in a young man who suffered a fall from a moving truck. The two commonest patterns were fractures of the shafts of the femur and tibia and fractures of the shaft of the femur and the tibial condyle. Clinics in orthopedic surgery. as an ipsilateral fracture of femur and tibia, nailing has been a treatment option in the ‘true’ floating knee; that is to say when none of the fractures are intra-articular. Magnetic resonance imaging of the knee after ipsilateral femur fracture Kyle F. Dickson, Mark W. Galland, Robert L. Barrack , Harold R. Neitzschman, Mitchel B. Harris, Leann Myers, Mark S. Vrahas Research output : Contribution to journal › Article › peer-review Ipsilateral fractures of the proximal femur and femoral shaft are rare injuries followed by high velocity trauma. To obtain a good functional result with no sequelae, the therapeutic choice depends on the Fraser classification, the existence or absence of bone comminution, articular type, and whether the fracture is open or closed. Proximal Third Tibia Fracture Tibial Shaft FX Ankle ... two 5-mm half-pins in distal femur, two in distal tibia. J Bone Joint Surg Am. Knee ligament injuries combined with ipsilateral tibial and femoral diaphyseal fractures: Blake R, Mcbryde A. Add to library View PDF. Distal femoral fraction gives better torsional control. The aim of our study is to evaluate clinical, functional and radiological outcomes of these injuries, managed surgically. They are almost always due to high-energy trauma. There were 7 femoral and 22 tibial open fractures. J Arthroplasty 2006,21(1):138-140. Ipsilateral femoral and tibial nailing increase malunion: shortening and rotational malunion. Winston Salem, NC: An … Rigid internal fixation of both the femur and the tibia in case of fracture through the shaft of both bones gave satisfactory functional end result. (ie, ipsilateral fractures of the femur and tibia) is uncommon. 7. Six patients had open fracture. When conducting the workup, it is important to remember that ipsilateral femoral neck fractures have a 2-6% incidence with femoral shaft … There has been no report on the fracture pattern, com-plications and surgical outcomes regarding ipsilateral hume-ral neck and shaft fracture in the literature, nor suggested fracture mechanism. Multiple traumatic injuries of the ipsilateral lower extremity (hip, femur, tibia) that would compromise outcome assessment 8. Patients presenting with floating knee injuries from the year 2011 to 2014 were included in the study. femur with ipsilateral tibia fracture. In five patients with ipsilateral femoral and tibial shaft fractures the Hoffmann apparatus was used to stabilize the fractures of both the femur and tibia. All were caused by road accidents. Management of ipsilateral distal tibia and ankle fractures. Functional Citations of this article. Mendeley users who have this article in their library. There were 20 men and 12 women with a mean age of 27 years (range 18-75 years). J Bone Joint Surg Br. Ipsilateral femoral neck and shaft fracture is well-reported, and this unique fracture is encountered in younger patients after high-energy trauma 2, 3. As a sequela of the injury 32 (33%) patients were left with a limb length discrepancy, 24 (25%) patients had lengthening of the injured limb at follow up, while 8 (8%) had shortening of the affected limb. We found that the lateral articular edge of the tibia was slightly lateral to the lateral articular edge of the femur (mean dLA, 0.9 ± 1 mm). 10 Citations. Management of intraoperative medial collateral ligament injury during TKA. Related articles Femur fracture floating knee intramedullary nailing single knee incision tibia fracture. There were 7 femoral and 22 tibial open fractures. The patients walked early and there were no disturbances of fracture healing. Ipsilateral fracture shafts of femur and tibia cause a floating knee injury. Ipsilateral fractures of the femur and the tibia are relatively uncommon lesions, with critical consequences to the knee. Abstract. It often follows road and external fixation take priority. These are often high-energy injuries and most frequently occur in the polytrauma patient. decreases rate of infection and wound healing complications. We describe a 34-year-old man with ipsilateral fractures of the femoral neck and shaft with an ipsilateral floating knee after a motorcycle collision. anesthesia for an ipsilateral fracture of the femur and tibia using high doses (30 mg) of 0.5% isobaric bupivacaine. The patients walked early and there were no disturbances of fracture healing. Thirty-two cases of simultaneous ipsilateral femoral and tibial fractures in thirty-one patients were treated by rigid internal or pin fixation of both fractures in fourteen cases, by rigid internal or pin fixation of one fracture in three, and by conservative management or non-rigid internal fixation in fifteen. This problem can be reduced but not eliminated by using locking nails: the error was established during the operation. Around 12% of patients present with a pathological fracture, ... fixed in both proximal femur and distal tibia. Correctly communicate the injury to the team. Thirty-two cases of simultaneous ipsilateral femoral and tibial fractures in thirty-one patients were treated by rigid internal or pin fixation of both fractures in fourteen cases, by rigid internal or pin fixation of one fracture in three, and by conservative management or non-rigid internal fixation in fifteen. McBryde noticed a high complication rate following this injury with an incidence of 60-70% permanent disability. 39 High rates of complications have been described. Emergency management of femur fractures. axial traction applied to fixator. Over 50% of the … This complex injury has increased in proportion to population growth, number of motor vehicles on the road, and high speed traffic. gency room with an ipsilateral proximal tibia and femoral Hoffa fracture, following road traffic acci-dent. Knee deformities were assessed by percentile and zone of mechanical axis … Management of ipsilateral supracondylar femur fractures following total knee arthroplasty. An 84 year-old female patient, who had had a total knee arthroplasty at the age of 78, fell down the stairs and was diagnosed with a supracondylar fracture of the right femur type II [] and metaphyseodiaphyseal type IIIA [] fracture of the ipsilateral tibia, with no evidence of implant loosening (Fig. injury with more than just ipsilateral fractures of the femur and tibia. Fourteen (67%) of the 21 patients sustained a total of 17 open fractures (76% of which were grade II or III wounds). Gregory P (1), DiCicco J, Karpik K, DiPasquale T, Herscovici D, Sanders R. J Korean Soc Fract 2000;13:837–846.

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