The term “floating knee,” introduced by Blake and McBryde in 197 is used to describe fractures of the ipsilateral femur and tibia. Fractures can occur anywhere along the femur and the tibia and must occur in both bones to be considered a floating knee injury.
Classification of Floating Knee
| Types | Blake-McBryde [1] | Bohn-Durbin [2] | Fraser [3] | Types | Letts-Vincent [4] |
| I | Double shaft | Double shaft | Without knee involvement | A | Closed – double shaft |
| II | Juxta-articular injuries | With knee involvement | B | Closed – 1 shaft + 1 metaphysis | |
| – IIa | With knee involvement | Tibial plateau | C | Closed – 1 shaft + 1 epiphysis | |
| – IIb | With hip or ankle joint involvement | Distal femur – intra-articular | D | 1 open fracture | |
| – IIc | Both tibial plateau & intra-articular distal femur | E | Both open fractures | ||
| III | Involvement of epiphysis (knee, hip, ankle) |
Management of Floating Knee [5]
| Injury personality | Management |
| 1. Unstable patient, Severe soft tissue damage or Vascular injury | Damage control (Spanning external fixation) |
| 2. Stable patient and Limb fit for surgery | Definitive fixation |
| a. Fraser I | 1. Femur retrograde nail 2. Tibia antegrade nail |
| b. Fraser IIa | 1. Femur retrograde nail 2. Tibia plating |
| c. Fraser IIb | 1. Tibia suprapatellar nail 2. Femur plating |
| d. Fraser IIc | 1. Tibia plating 2. Femur plating |
- Blake R, McBryde A. The floating knee: Ipsilateral fractures of the tibia and femur. South Med J. 1975 Jan;68(1):13-6.
- Anari JB, Neuwirth AL, Horn BD, Baldwin KD. Ipsilateral femur and tibia fractures in pediatric patients: A systematic review. World J Orthop. 2017 Aug 18;8(8):638-643.
- Fraser RD, Hunter GA, Waddell JP. Ipsilateral fracture of the femur and tibia. J Bone Joint Surg Br. 1978 Nov;60-B(4):510-5.
- Letts M, Vincent N. The pediatric floating knee. J Bone Joint Surg Br. 1986;68(3):442-6.
- Piedra-Calle CA, García-Sánchez Y, Teixidor-Serra J, Tomás-Hernández J, Selga-Marsá J, Porcel-Vázquez JA, Molero-García V, Andrés-Peiró JV. Challenges and outcomes in the treatment of floating knees. A case series of ipsilateral femur and tibia fractures around the knee. Eur J Orthop Surg Traumatol. 2022 Feb;32(2):325-331. doi: 10.1007/s00590-021-02981-7. Epub 2021 Apr 21. PMID: 33884493.
He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music. He is currently pursuing Fellowship in Hip, Pelvi-acetabulum and Arthroplasty at B&B Hospital.
