HÜSEYİN ARSLAN, Ahmet KAPUKAYA, Cumhur Cevdet KESEMENLİ, Serdar NECMİOĞLU, Mehmet SUBAŞI, Vafi ÇOBAN

Yirmi dört olguda ipsilateral ve tibia kırığı erişkinlerde "floating knee"

Amaç: Erişkinlerde karşılaşılan ipsilateral femur ve tibia kırıklarının özellikleri ve kırığın tipinin ve iskeletsel yaralanma derecesinin sonuçlara olan etkisi değerlendirildi. Çalışma planı: Çalışmaya 24 hasta (22 erkek, 2 kadın; ört. yaş 38; dağılım 17-75) alındı. Letts ve ark.nın sınıflandırmasına göre kırıkların yedisi tip A, ikisi tip B, beşi tip C, yedisi tip D, üçü tip E olarak belirlendi. Femur kırıkları kilitli Intramedüller çivi, AO plak, düz plakvida, tek taraflı eksternal fiksatör veya dinamik kendiler vida ile tedavi edildi. Tibia kırıkları ise eksternal fiksatör, plak-vida, intramedüller kilitli çivileme ya da konservatif yöntemle tedavi edildi. Tip 3C açık tibia kırığı olan bir hasta-ya kırık seviyesinde aınputasyon yapıldı. Hastalar ortalama 3.2 yıl (dağılım 1.3-7 yıl) izlendi. Sonuçlar: Kalström ve Olerud'un ölçütlerine göre üç hastada mükemmel, dokuz hastada iyi, beş hastada yetersiz, altı hastada kötü sonuç alındı. Ekstremite yaralanma derecesi, yetersiz ve kötü sonuç alınan hastalarda 4.4, iyi ve mükemmel sonuç alınanlarda 3 bulundu. Yetersiz ve kötü sonuç alınan bir hastada tip A, diğerlerinde ise C, D veya E tipinde kırık olduğu gözlendi. Tibiasında tip 3 açık kırığı olan beş hastada yetersiz veya kötü sonuç alındı. On üç hastada (%54) en az bir komplikasyon oluştu. Çıkarımlar: Açık ve diz eklemiyle ilişkili olmaları nedeniyle tip C, D ve E kırıklarda ve iskeletsel yaralanma derecesi yüksek hastalarda yetersiz ve kötü sonuç daha fazla görülmektedir. Tedavide ideal bir tespit yöntemi olmamakla birlikte, sıkı internal fiksasyon, tip 3 tibia açık kırıkları dışında tercih edilmelidir.

Anahtar Kelimeler:

Kazalar, trafik, Kırık tespiti, internal, Diz yaralanmaları, Kırık tespiti, intramedüller, Femur kırıkları, Diz eklemi, Çoklu travma, Tibia kırıkları

The floating knee in adults. Twenty-four cases of ipsilateral fractures of the femur and the tibia

Objectives: We evaluated the presenting features of ipsilateral femoral and tibial fractures in adults, and the effects of both fracture type and severity of skeletal injury on the results. Methods: The study included 24 patients (22 men, 2 women; mean age 38 years; range 17 to 75 years). According to the classification by Letts et al., the types of the fractures were as follows: type A (7), type B (2), type C (5), type D (7), and type E (3). Femur fractures were treated by locked intramedullary nails, AO plates, plate-screws, unilateral external fixator, or dynamic condylar screws, and tibia fractures by external fixator, plate-screws, locked intramedullary nailing, or with conservative methods. Amputation at the fracture level was required in a patient with type 3C open tibia fracture. The mean follow-up was 3.2 years (range 1.3 to 7 years). Results: According to the criteria by Kalström and Olerud, the results were excellent in three patients, good in nine patients, fair in five patients, and poor in six patients. The mean skeletal injury scores were 4.4 and 3 in patients having fair and poor results and in those with good and excellent results, respectively. Fair and poor results corresponded to type A (1 patient), type C, type D, or type E fractures. Five patients with type 3 open fractures had fair or poor results. Thirteen patients (54%) had at least one complication. Conclusion: Patients with type C, D, or E fractures and those with greater skeletal injury scores are more likely to have fair or poor results due to the open nature of the fracture and to increased involvement of the knee joint. Although there is not an ideal method, rigid internal fixation seems to be more appropriate in fractures other than type 3 open tibia fractures.

Keywords:

Accidents, Traffic, Fracture Fixation, Internal, Knee Injuries, Fracture Fixation, Intramedullary, Femoral Fractures, Knee Joint, Multiple Trauma, Tibial Fractures,

PDF

___

1.Blake R, McBryde A Jr. The floating knee: Ipsilateral fractures of the tibia and femur. South Med J 1975;68:13-6.
2. Karlstrom G, Olerud S. Ipsilateral fracture of the femur and tibia. J Bone Joint Surg [Am] 1977;59:240-3.
3.Veith RG, Winquist RA, Hansen ST Jr. Ipsilateral fractures of the femur and tibia. A report of fifty-seven consecutive cases. J Bone Joint Surg [Am] 1984;66:991-1002.
4.Theodoratos G, Papanikolaou A, Apergis E, Maris J. Simultaneous ipsilateral diaphyseal fractures of the femur and tibia: treatment and complications. Injury 2001;32: 313 -5 .
5.van Raay JJ, Raaymakers EL, Dupree HW. Knee ligament injuries combined with ipsilateral tibial and femoral diaphyseal fractures: the "floating knee". Arch Orthop Trauma Surg 1991;110:75-7.
6.Ostrum RF. Treatment of floating knee injuries through a single percutaneous approach. Clin Orthop 2000;(375):43-50.
7.Behr JT, Apel DM, Pinzur MS, Dobozi WR, Behr MJ. Flexible intramedullary nails for ipsilateral femoral and tibial fractures. J Trauma 1987;27:1354-7.
8.Anastopoulos G, Assimakopoulos A, Exarchou E, Pantazopoulos T. Ipsilateral fractures of the femur and tibia. Injury 1992;23:439-41.
9.Hung SH, Chen TB, Cheng YM, Cheng NJ, Lin SY. Concomitant fractures of the ipsilateral femur and tibia with intra-articular extension into the knee joint. J Trauma 2000; 48:547-51.
10.Hee HT, Wong HP, Low YP, Myers L. Predictors of outcome of floating knee injuries in adults: 89 patients followed for 2-12 years. Acta Orthop Scand 2001;72:385-94.
11.Letts M, Vincent N, Gouw G. The "floating knee" in children. J Bone Joint Surg [Br] 1986;68:442-6.
12.Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14:187-96.
13.Bohn WW, Durbin RA. Ipsilateral fractures of the femur and tibia in children and adolescents. J Bone Joint Surg [Am] 1991;73:429-39.
14.Bansal VP, Singhal V, Mam MK, Gill SS. The floating knee. 40 cases of ipsilateral fractures of the femur and the tibia. Int Orthop 1984;8:183-7.
15.Gregory P, DiCicco J, Karpik K, DiPasquale T, Herscovici D, Sanders R. Ipsilateral fractures of the femur and tibia: treatment with retrograde femoral nailing and unreamed tibial nailing. J Orthop Trauma 1996;10:309-16.