Short term functional outcome analysis following fixation for floating knee injuries: A prospective study

Pooranna Raja, T (2015) Short term functional outcome analysis following fixation for floating knee injuries: A prospective study. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION : Floating knee injuries are relatively rare and complex injuries. The type of fractures, soft tissue and associated injuries make this a challenging problem to manage. The incidence of fractures resulting from motor vehicle accidents is on the rise. High velocity accidents are now more common producing violent and complex injuries. Floating knee refers to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur & tibia. The fracture may be simple diaphyseal to complex intra articular types. This has increased in the proportion to population growth, number of motor vehicles on the road, and high speed traffic. AIMS AND OBJECTIVES : 1) To evaluate 27 cases of floating knee injuries which have been treated with various modalities of treatment as per the fracture pattern. 2) To analyse the short term functional outcome following definitive fixation of these injuries using Karlstrom Olerud criteria. MATERIALS AND METHODS: Data collection and methods: collection of data as per the proforma with consent from the patients admitted in the Orthopaedic department, Govt.Royapettah hospital , Kilpauk medical college , Chennai. Inclusion criteria: 1) Patients in the age group of above 18 years, 2) Both male and female patients, 3) Patients with ipsilateral fractures of femur and tibia, 4) Closed and compound floating knee injuries, 5) Floating knee injury patients with other associated injuries. Exclusion criteria: 1) Age less than 18 years, 2) Pathological fractures, 3) Associated neuro- vascular damage of the affected limb. Methodology: All the trauma victims received in the casualty will be immediately started on ATLS protocol giving due importance to their Airway, Breathing and Circulation. Serial monitoring of the blood pressure, pulse rate and oxygen saturation (SpO2) done in the emergency room. Once the patient is hemodynamically stabilised, thorough search for any life threatening injuries done in the casualty. RESULTS: Functional outcome of patients with floating knee injuries were measured following bony union. Factors which may influence bony union in these patients were, associated fractures and their management, intra- operative and post-operative complications. CONCLUSION: Floating knee injuries are more complex injuries. In our study we found that most of the patients belonged to the working population ranging from 25 – 35 years and most of the patients were male patients. Most of the injury pattern in our study belonged to Type I Fraser injury with both femoral and tibial side being shaft fractures. Type I Fraser injuries managed with intra-medullary nailing for both fractures tend to have better functional outcome and knee range of movements when compared to intra-articular fractures and compound injuries. Compound injuries and soft tissue injuries were common with these group of patients. Associated injuries were common in these group of patients. It may range from ipsilateral limb injury to life threatening other system injuries requiring early resuscitation. Initial resuscitation based on ATLS protocol, selecting the correct timing of definitive fixation, understanding and knowledge regarding biochemical inflammatory markers help to minimize the second hit in these patients with extensive injury. Intra-operative and post-operative complications are common with these group of patients which may range from infection to life threatening problems like ARDS/MODS.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Short term functional outcome analysis ; fixation ; floating knee injuries ; prospective study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 25 Sep 2017 03:13
Last Modified: 25 Sep 2017 03:13
URI: http://repository-tnmgrmu.ac.in/id/eprint/3320

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