2017 ISAKOS Biennial Congress ePoster #1627

 

A Comprehensive Classification To Prognosticate The Outcome Of Floating Knee Injuries; Are We Justified.

Prahalad Kumar Singhi, MBBS, DOrtho, DNB(Ortho), Madurai, Tamilnadu INDIA
Somashekar V, MS (Orth), Madurai, TAMILNADU INDIA
Vanaj Kumar, MS (Orth), Madurai, TAMILNADU INDIA
Sivakumar Raju, Prof, Madurai, TAMILNADU INDIA

Preethi Hospitals Pvt Ltd, MADURAI, TAMILNADU, INDIA

FDA Status Not Applicable

Summary

Floating knee is a complex injury, so a more comprehensive classification is needed to better prognosticate these injuries

Abstract

Floating knee injury is a term coined by Blake and McBryde; it’s a simultaneous breach of skeletal integrity above and below the knee joint. Several classification systems have been described to classify these injuries; still most studies feel they are inadequate to prognosticate the outcome. These are high velocity injuries, and more than one classification system like Frasers, Blake and McBryde, Gustilo and Andersons and AO Classification for comminution and several other factors which influence need to be included in a comprehensive classification system.
We at our tertiary centre have introduced a comprehensive classification combining all above classifications along with disruption of extensor mechanism, avulsion fractures around knee, fractures around hip and ankle, and applied it to all our 106 cases of floating knee presented between 2008 and 2015 who survived on injury severity score. Outcome was assessed using modified Karlstrom and Olerud scoring after fracture union. On statistical analysis the predictability of need for multiple procedures, number of days of hospitalization, fracture union, complications and outcome among different types were significant and comparable with frasers.

Results

The mean follow up was 21.6 months with a minimum follow up of 12 months and maximum of 70 months. The average time for union was 22 weeks for femur and 19 weeks for tibia. The clinical result was assessed by the Karlstrom and Olerud score. At 12 months the results were excellent in 29 (27%), Good in 37 (35%), acceptable in 33 (31%) and poor in 7 patients (7%). Statistical analysis showed number of days of hospitalisation and number of procedures when compared between different groups of authors classification I and IV was statistically significant (p= 0.004). Post hoc comparison indicates that class I and IV were statistically different with p= 0.006; however the other class did not show any significant difference. There is a trend towards significance between class I and II (p= 0.066).

Author’s classification enables the surgeon to plan the management and prognosticate the outcome. We would like to perform a multicentre study in near future so that this classification system better validated.