Floating knee

Last revised by Henry Knipe on 22 Oct 2022

Floating knees occur when there are ipsilateral fractures of both femoral and tibial shafts. These are relatively rare injuries with reported poor outcomes.

The usual presentation is a combined closed midshaft femoral fracture and open midshaft tibial fracture. Vascular injury is present in about 20% of the patients. Due to the high-energy trauma, it is common for the patient to also present associated injuries, such as contralateral limb injury, knee ligament injury, and head trauma.

Floating knee injuries are often the result of high-energy trauma, mostly traffic accidents.

  • type I: none of the fractures is juxta-articular

  • type II: one of the fractures is juxta-articular

    • type IIA: femoral fracture involves the condylar flare

    • type IIB: tibial fracture involves the condylar flare

  • type III: both fractures are juxta-articular

Floating knee injuries are historically associated with poor functional outcomes.

Some of the possible treatment options are:

  • non-operative treatment - closed reduction and hinged functional brace

  • internal fixation of the femur and closed reduction and functional cast bracing of the tibia

  • intramedullary nailing

  • external fixation

  • Amputation

Intramedullary nailing has been reported with better functional outcomes compared to the other treatment methods.

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Cases and figures

  • Case 1
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  • Case 2
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