Publication:

A rare case of a floating knee concomitant with an ipsilateral floating hip and a bimalleolar fracture

An ipsilateral floating knee and hip is an extremely rare condition that is associated with a life threatening condition. So its correct management, is essential to mantain a stable hemodynamic condition. We reported our management for this fracture in order to underline the rareness, the severity of this entity and highlight the importance of damage control to respond to this. A 71-year-old female referred to our hospital after motor vehicle accident. At arrival, the patient was hemodynamically unstable and went directly to the emergency room, which was reverted. In physical examination there was a swollen thigh, without neurovascular deficits. X-rays reveal a LC type 1 fracture with sacrum, superior and inferior pubic ramus compression fracture, a wedge extra-articular distal femur fracture, a transverse tibial shaft fracture and a bimalleolar fracture. Then in the operation room the patient become unstable hemodynamically, and it was decided to do a reduction and fixation with an external fixator in the femur shaft and in the tibiotarsi joint, which enable the patient recovery. After 7 days, the patient still stable hemodynamically and a retrograde femoral nailing and an anterograde tibial nailing was made. Due to lack of skin conditions, the bimalleolar fixation was postponed to thirteen days after when its osteosynthesis was performed. The LC type 1 fracture underwent osteosynthesis with two percutaneous partially-threaded screws. Then the patient underwent to a rehabilitation protocol. Follow-up appointments showed good radiologic and clinically evolution. At 6 months revealed a complete return to normal daily life, without limitation or pain. In our work, we highlight the rareness and the severity of this injuries and the need of the damage control approach due to the hemodynamic unstableness of this kind of patients.