Floating Knee Injury

High Yield Overview

FLOATING KNEE INJURY

Ipsilateral Femur + Tibia | Fraser Classification | High-Energy Polytrauma

80%Have associated injuries (polytrauma)

Greater than 50%Occult knee ligament injury

5-15%Mortality rate

Type IBest prognosis (both extra-articular)

Fraser Classification

Type I

PatternBoth extra-articular

TreatmentDouble IM nailing (Antegrade femur + Tibia)

Type IIA

PatternTibial articular extension

TreatmentFemur nailing + Tibial plateau ORIF

Type IIB

PatternFemoral articular extension

TreatmentDistal femur ORIF + Tibial nailing

Type IIC

PatternBoth articular

TreatmentDual ORIF (Distal femur + Tibial plateau)

Critical Must-Knows

Fraser Classification: Type I (both extra-articular = best), IIA (tibial articular), IIB (femoral articular), IIC (both = worst)
Ligamentous injury in 50%+ - often missed initially due to swelling/pain. Always reassess and MRI when stable
Stabilise BOTH fractures - typically IM nails if extra-articular. Same sitting reduces complications
Damage control if patient unstable: spanning external fixation of both, definitive fixation when resuscitated
Vascular injury and compartment syndrome (thigh AND leg) must be assessed

Examiner's Pearls

"
Femur first usually preferred - restores limb length, facilitates tibial reduction
"
Type IIC (both articular) has worst prognosis - complex surgical management required
"
Knee stiffness is common complication - early mobilisation essential
"
Open fractures common in this high-energy pattern

Clinical Imaging

Imaging Gallery

Floating knee injury showing damage control to definitive fixation sequence — Complete management sequence for a polytraumatized 35-year-old male with bilateral femoral fractures and tibial fracture (ISS 42). (a) Pre-operative radiographs showing comminuted fractures of both femurs and the right tibia - a bilateral floating knee pattern. (b) Damage control phase with spanning external fixators providing temporary stabilization while the patient is resuscitated. (c) Definitive fixation with antegrade intramedullary nails in the femurs and tibia, allowing early mobilization. This demonstrates the staged approach for hemodynamically unstable polytrauma patients.Credit: Lavini F et al. via Strategies Trauma Limb Reconstr (CC BY)

Fraser Type I floating knee with IM nail fixation — Preoperative radiographs of a 41-year-old male with a Fraser Type I floating knee injury (both extra-articular). Left: distal femur showing the knee joint. Center: AO Type A3 femoral shaft fracture with short oblique pattern. Right: AO Type A3 tibial shaft fracture. This pattern is amenable to double intramedullary nailing (antegrade femoral nail + tibial nail) and carries the best prognosis among floating knee injuries.Credit: Zoccali C et al. via J Orthop Traumatol (CC BY)

Exam Warning

Fraser Classification

Articular = Bad. Type I (Extra-articular) is best. Type IIC (Both articular) is worst.

Hidden Injury

Ligaments. Greater than 50% have ACL/PCL tears. Often missed due to swelling/pain.

Double Danger

Compartment Syndrome. Assess BOTH thigh and leg compartments closely.

At a Glance

Floating knee injury describes ipsilateral femur and tibia fractures creating an unstable knee segment disconnected from axial skeleton. It results from high-energy trauma (MVA, motorcycle accidents) with associated injuries in 80% and mortality of 5-15%. The Fraser classification determines prognosis: Type I (both extra-articular, best prognosis), Type IIA (tibial articular), Type IIB (femoral articular), Type IIC (both articular, worst prognosis). Management involves stabilization of both fractures, typically with intramedullary nailing if extra-articular. Critical associated injuries include ligamentous knee injury (greater than 50%, often missed initially), vascular injury requiring angiography, and compartment syndrome in both thigh and leg.

Mnemonic

I-ABCFraser Classification

Extra-articular Both

Best prognosis - both IM nailable

Articular Tibia

Type IIA - tibial plateau involvement

Bone (Femur) articular

Type IIB - distal femur involvement

Combined

Type IIC - both articular = worst

Memory Hook:I-ABC: I for extra-articular (Individual bones), ABC for articular (A=tibia, B=femur, C=Combined)

Mnemonic

CLVNFloating Knee Assessment

Compartments

Check BOTH thigh AND leg compartments

Ligaments

50%+ have knee ligament injury (often occult)

Vascular

Popliteal artery at risk - assess DP/PT pulses

Nerve

Peroneal nerve most vulnerable

Memory Hook:CLVN: Check Limbs, Vessels, Nerves for compartment and vascular safety

Mnemonic

F-T-SManagement Sequence

Femur First

Restores limb length, facilitates tibial reduction

Tibia Second

IM nail if extra-articular, ORIF if plateau

Same Sitting

Reduces complications, shortens hospital stay

Memory Hook:F-T-S: Femur restores length, Tibia follows, Same sitting for efficiency

Overview

Floating knee injury describes ipsilateral fractures of the femur and tibia, creating an unstable knee segment that is disconnected from the axial skeleton. The term reflects the biomechanical reality that the knee "floats" free between two fracture sites.

Epidemiology

Incidence: Accounts for 2-4% of lower extremity fractures
Demographics: Male predominance (3:1), peak age 20-40 years
Mechanism: High-energy trauma (MVA 70%, motorcycle 20%, pedestrian vs vehicle 5%)
Polytrauma association: Present in 70-80% of cases
Mortality: 5-15% (usually from associated injuries)
Open fracture rate: 30-40%

Associated Injuries

Injury Type	Incidence	Clinical Significance
Knee ligament injury	50-70%	Often missed initially, affects rehabilitation
Vascular injury	5-10%	Limb-threatening, requires urgent assessment
Compartment syndrome	10-20%	Both thigh and leg at risk
Ipsilateral hip/ankle	15-20%	Must image entire limb
Head/chest/abdominal	40-60%	ATLS priorities

Anatomy and Biomechanics

Relevant Anatomy

Knee as the "Floating" Segment:

The knee joint and surrounding soft tissues become an unstable segment
Disconnected superiorly by femur fracture and inferiorly by tibia fracture
Popliteal vessels and nerves traverse this zone

Critical Vascular Anatomy:

Popliteal artery: Fixed at adductor hiatus proximally and soleus arch distally
Tethered position makes it vulnerable to traction injury
Intimal tears may cause delayed thrombosis

Muscular Attachments:

Quadriceps mechanism spans the femur fracture
Gastrocnemius origin crosses the knee
These contribute to deforming forces and stiffness

Biomechanical Considerations

Deforming Forces:

Femur: Proximal fragment abducted and flexed (iliopsoas, abductors)
Tibia: Variable depending on fracture level
Knee tends toward flexion contracture if not mobilized early

Load Transmission:

Normal: Axial load through femur → knee → tibia
Floating knee: Complete loss of axial stability
Requires fixation of BOTH fractures for weight-bearing

Classification Systems

Fraser Classification

Type	Femur	Tibia	Prognosis
Type I	Shaft (Extra-articular)	Shaft (Extra-articular)	Best (75-85% Excellent)
Type IIA	Shaft	Articular (Plateau)	Moderate (60-70% Good)
Type IIB	Articular (Condyle)	Shaft	Poor (55-65% Good)
Type IIC	Articular (Condyle)	Articular (Plateau)	Worst (45-55% Good)

The Fraser system remains the definitive classification for these injuries.

Clinical Assessment

Initial Trauma Evaluation

ATLS Priorities:

High-energy polytrauma focus
Associated injuries in 80% (Head, Chest, Abdo)
Hemodynamic stability assessment first

Limb Assessment:

Obvious deformity and length discrepancy
Skin integrity (open fractures common)
Compartment Monitoring: Both thigh (3 compartments) and leg (4 compartments)
Vascular Exam: Popliteal, DP, PT pulses; ABI if suspicious
Neurological Exam: Peroneal nerve (most vulnerable)

Assessment of the "floating" segment is secondary to life-saving measures.

Investigations

Radiographic Series

Standard Trauma Series:

Full-length femur (AP/Lateral)
Full-length tibia (AP/Lateral)
AP Pelvis (check for associated hip fractures)
Dedicated Knee Series (AP/Lateral/Oblique)

Assessment checklist:

Identify fracture location (diaphyseal vs articular)
Assess for comminution
Check joint congruity

A true lateral of the knee is essential to rule out occult subluxation.

Management Algorithm

Algorithm should be interpreted in context of overall trauma status.

Ligamentous Injury

More than 50% of floating knee injuries have associated knee ligament damage, but this is often occult initially due to swelling and pain. Always assess the knee once fractures are stabilised and obtain MRI when appropriate.

Clinical Context: Ligamentous injury significantly affects rehabilitation and outcomes.

Management

Damage Control vs Definitive

Damage Control Phase (Unstable Patient):

Spanning external fixation of both femur and tibia
Temporary stabilisation to allow resuscitation
Definitive fixation once physiological parameters normalise

Definitive Fixation (Stable Patient):

Address both fractures at same sitting if possible
Reduces hospital stay and allows early motion

Fixation Strategies by Fraser Type:

Fraser Type I: Double IM nailing (Antegrade femur + Tibia)
Fraser Type IIA: Femur nailing + Tibial plateau ORIF
Fraser Type IIB: Distal femur ORIF + Tibial nailing
Fraser Type IIC: Dual ORIF (Distal femur + Tibial plateau)

Fixation strategy must be tailored to specific fracture patterns.

Sequence of Fixation

Most surgeons prefer femur first:

Restores limb length and gross alignment
Facilitates subsequent tibial reduction
More ergonomic patient positioning

Tibial fixation follows immediately to finalize the construct stability.

Surgical Technique

Femoral Techniques

Intramedullary Nailing:

Entry: Piriformis or greater trochanteric
Reamed nailing preferred for stability
Interlocking screws to control rotation

ORIF (Distal Femur):

Lateral parapatellar approach
Anatomic articular reduction first
Locking plate or retrograde nail depending on complexity

Bone quality and comminution dictate the final implant choice.

Complications

Early Complications

Compartment Syndrome (10-20%):

Affects both thigh AND leg compartments
Thigh contains 3 compartments (Often overlooked)
Maintain high index of suspicion with serial evaluations
Threshold for prophylactic fasciotomy should be low

Vascular Injury (5-10%):

Popliteal artery most at risk due to tethered anatomy
May present delayed due to intimal injury
Requires immediate revascularization if diagnosed
Limb viability window: 6-8 hours warm ischemia

Infection:

Higher rates than isolated fractures (10-15%)
Open fractures require debridement and antibiotics per Gustilo protocol
External fixation pin site infections

Late Complications

Knee Stiffness (20-50%):

Most common long-term problem
Due to periarticular scarring and quadriceps adhesions
Prevention: Early ROM, avoid prolonged immobilization
Treatment: Aggressive physiotherapy, consider manipulation under anesthesia

Malunion/Nonunion:

Both fracture sites at risk
Smoking, diabetes, and infection increase risk
May require revision fixation or bone grafting

Post-traumatic Arthritis:

Particularly prevalent in Fraser Type II injuries
Articular damage + ligament instability contribute
May require total knee arthroplasty in the long term

Postoperative Care

Immediate Postoperative

Day 0-3:

DVT prophylaxis (LMWH)
Pain management (multimodal analgesia)
Neurovascular monitoring
Wound inspection

Early Mobilization:

CPM or active-assisted ROM from day 1 if stable fixation
Quadriceps setting exercises
Ankle pumps

Weight-Bearing Protocol

Fracture Pattern	Weight-Bearing Status	Duration
Type I (both IM nails)	Touch weight-bearing → progressive	6-12 weeks
Type II (articular)	Non-weight-bearing → partial	8-12 weeks
External fixation	Non-weight-bearing	Until definitive fixation

Rehabilitation Phases

Phase 1 (0-6 weeks):

ROM exercises (goal: 0-90° knee flexion)
Quadriceps strengthening (isometric initially)
Gait training with assistive devices

Phase 2 (6-12 weeks):

Progressive weight-bearing
Active ROM to full
Closed chain exercises
Aquatic therapy if available

**Phase 3 (12+ weeks):

Full weight-bearing
Functional training
Return to activity assessment
Address remaining ligamentous instability

Outcomes

Functional Recovery

Return to Work:

60-70% return to pre-injury occupation
Average time: 9-12 months
Manual laborers typically have worse outcomes

Outcome Measures:

Knee Society Score
WOMAC
SF-36

Prognostic Factors (AOA context): Type II injuries (articular) carry a significantly higher burden of post-traumatic OA.

Evidence Base

Fraser Classification and Outcomes

Fraser RD, Hunter GA, Waddell JP • J Bone Joint Surg Br (1978)

Key Findings:

Original description of floating knee classification
Type II (articular) injuries had significantly worse outcomes
Knee stiffness was the most common complication
Early mobilization improved functional results

Clinical Implication: Fraser classification remains the standard for prognostication and surgical planning.

Ipsilateral Fractures of the Femur and Tibia

Veith RG, Winquist RA, Hansen ST Jr • J Bone Joint Surg Am (1984)

Key Findings:

Study of 57 patients with floating knee injuries
Advocated for rigid internal fixation of both fractures
Reported significantly better results with intramedullary nailing
Complications included infection (12%) and nonunion (5%)

Clinical Implication: Pioneering study supporting the move towards aggressive internal fixation for limb salvage.

Single-Stage Fixation for Floating Knee

Rethnam U, Yesupalan RS, Nair R • Eur J Trauma Emerg Surg (2007)

Key Findings:

Single-stage fixation of both fractures is safe and effective
Reduced hospital stay compared to staged procedures
No increase in complication rates
Better functional outcomes with early knee mobilization

Clinical Implication: Single-stage definitive fixation is preferred in hemodynamically stable patients.

Ligamentous Injuries in Floating Knee

Szalay MJ, Hosking OR, Annear P • J Bone Joint Surg Br (1990)

Key Findings:

Ligament injuries present in 53% of floating knee cases
ACL most commonly injured
Often unrecognized at initial presentation
Affects long-term knee function

Clinical Implication: All floating knee patients should have formal ligament assessment once stable.

Damage Control Orthopaedics in Polytrauma

Pape HC, Giannoudis P, Krettek C • Clin Orthop Relat Res (2002)

Key Findings:

Damage control reduces systemic inflammatory response
External fixation as temporizing measure
Definitive fixation when patient optimized
Reduces ARDS and multi-organ failure

Clinical Implication: Damage control orthopaedics is appropriate for unstable polytrauma patients.

Exam Viva Scenarios

Practice these scenarios to excel in your viva examination

VIVA SCENARIOStandard

Scenario 1: Fraser Type I Floating Knee - Single-Stage Fixation

EXAMINER

"A 28-year-old motorcyclist is brought to ED after a high-speed collision. He has obvious deformity of his left thigh and leg. X-rays show a mid-shaft femur fracture and a proximal tibial shaft fracture. He is haemodynamically stable. How do you manage this?"

EXCEPTIONAL ANSWER

This is a Fraser Type I floating knee injury - ipsilateral femur and tibia fractures creating an unstable knee segment that 'floats' disconnected from the axial skeleton. Both fractures are extra-articular (diaphyseal), which is the best prognostic category. My immediate assessment follows ATLS principles. After primary survey ensuring no life-threatening injuries, I would perform a thorough secondary survey. I would document neurovascular status carefully - popliteal artery injury occurs in 5-10% due to tethering. I would check distal pulses and obtain ankle-brachial index with threshold less than 0.9 requiring CT angiography. Critical is assessment of compartments in both the thigh and leg as compartment syndrome risk is 10-20%. I would assess skin integrity for open fractures. Since he is stable, I would plan single-stage definitive fixation of both fractures. My surgical approach would be to fix the femur first to restore limb length and alignment, facilitating subsequent tibial reduction. I would use antegrade femoral intramedullary nailing. After femoral fixation, I would proceed to tibial IM nailing using a suprapatellar approach. Intraoperatively after both fractures are stabilized, I would stress the knee under fluoroscopy to assess ligament integrity. I would also palpate all compartments post-fixation. Post-operatively, DVT prophylaxis is essential. I would plan MRI knee once swelling subsides to formally assess ligaments. Rehabilitation focuses on early knee ROM from day 1, quadriceps setting, and progressive weight-bearing over 6-12 weeks.

KEY POINTS TO SCORE

Fraser Type I (both extra-articular) has best prognosis

Assess for polytrauma (80% associated injuries), vascular injury, compartment syndrome

Single-stage definitive fixation preferred in stable patients - femur first then tibia

Knee ligament injury in 50%+ - stress under anesthesia, MRI when stable

Early knee ROM critical to prevent stiffness

COMMON TRAPS

✗Missing compartment syndrome in thigh

✗Not assessing knee ligaments

✗Delaying definitive fixation in stable patient

✗Inadequate vascular assessment

LIKELY FOLLOW-UPS

"How do you assess for compartment syndrome in the thigh and what are the compartments?"

"If the tibial fracture was articular (Type IIA), how would your management change?"

"When would you use damage control orthopaedics?"

VIVA SCENARIOChallenging

Scenario 2: Fraser Type IIC - Complex Articular Injury

EXAMINER

"A 35-year-old construction worker falls 4 meters from scaffolding landing on his left leg. X-rays show a comminuted distal femur fracture and a bicondylar tibial plateau fracture (Schatzker VI pattern). How would you approach this challenging injury?"

EXCEPTIONAL ANSWER

This is a Fraser Type IIC floating knee - the worst prognostic category with both femoral and tibial articular involvement. This pattern has significantly worse outcomes compared to Type I. My immediate concerns are: the tense swollen knee suggesting possible vascular compromise or impending compartment syndrome, and the complex articular injuries requiring meticulous planning. I would assessment limb vascularity and compartment status urgently. For imaging, CT with 3D reconstruction of both the distal femur and proximal tibia is essential. My surgical strategy mandates anatomic reduction. I would still sequence femur first to restore limb alignment. For the distal femur, I would perform anatomic articular reduction and definitively fix with either a lateral distal femoral locking plate. For the tibial plateau, the Schatzker VI bicondylar pattern requires addressing both medial and lateral columns, likely needing dual plating. The goal is articular step-off less than 2mm and restoration of mechanical axis. Post-operatively, this patient requires non-weight-bearing for 8-12 weeks, which significantly increases the risk of stiffness. I would use CPM immediately and work aggressively on ROM, but must balance this against risking loss of reduction. I would counsel realistically - only 45-55% achieve good outcomes, and return to manual labor may not be possible.

KEY POINTS TO SCORE

Fraser Type IIC (both articular) has worst prognosis

CT with 3D reconstruction essential for surgical planning

Articular injuries require anatomic reduction (less than 2mm step-off)

Dual plating often needed for both distal femur and proximal tibia

Realistic counseling regarding Stiffness and OA

COMMON TRAPS

✗Attempting IM nailing for articular fractures

✗Not obtaining CT for surgical planning

✗Over-optimistic expectations

✗Prolonged immobilization leading to severe stiffness

LIKELY FOLLOW-UPS

"What is your threshold for accepting articular step-off in the knee joint?"

"How would you manage if both fractures are too comminuted for stable fixation?"

"What are the indications for dual plating in tibial plateau fractures?"

VIVA SCENARIOCritical

Scenario 3: Floating Knee with Popliteal Artery Injury - Limb Salvage

EXAMINER

"A 42-year-old presents following a motor vehicle accident with a floating knee injury. His left leg is pale and cool with absent pulses. CT angiography confirms popliteal artery transection. How do you manage this?"

EXCEPTIONAL ANSWER

This is a surgical emergency requiring immediate revascularization. The critical issue is the warm ischemia time window of 6-8 hours. I would urgently transfer to the operating theatre for coordinated vascular and orthopedic intervention. My sequence would be: rapid skeletal stabilization FIRST with spanning external fixation (pins proximal and distal to fractures) achieving length and alignment. This takes 20-30 minutes and provides a stable scaffold for vascular repair. If stabilization would take longer, I should place a temporary intraluminal shunt first. The vascular team would then perform saphenous vein interposition graft repair. After revascularization, I must address compartment syndrome with immediate four-compartment leg fasciotomies (and potentially thigh fasciotomies). The wounds are left open for delayed management. Post-OP monitoring for rhabdomyolysis and hyperkalemia in ICU. Conversion to definitive fixation occurs when soft tissues permit (7-14 days). I would counsel realistically regarding the 10-20% amputation risk despite successful initial repair and the likely long-term functional deficits.

KEY POINTS TO SCORE

Popliteal artery injury = limb-threatening emergency

Sequence: Rapid skeletal stabilization with external fixation THEN vascular repair

Vascular repair: Reversed saphenous vein graft for defects

Immediate four-compartment leg fasciotomies post-revascularization

MESS score greater than 7 predicts poor salvage outcomes

COMMON TRAPS

✗Delaying vascular repair for long skeletal fixation

✗Attempting repair without stable bony scaffold

✗Missing compartment syndrome post-perfusion

✗Over-optimistic regarding mangled extremity salvage

LIKELY FOLLOW-UPS

"Describe the MESS score and when you would consider primary amputation"

"What metabolic derangements occur after revascularization?"

"How do you perform a four-compartment fasciotomy of the leg?"

MCQ Practice Points

Exam Pearl

Q: What is a floating knee injury and what is the Fraser classification?

A: Floating knee: Ipsilateral fractures of the femur and tibia, isolating the knee segment. Fraser classification: Type I: Diaphyseal fractures of both bones (extra-articular). Type IIa: Tibial plateau involvement (intra-articular tibia). Type IIb: Distal femur involvement (intra-articular femur). Type IIc: Both articular surfaces involved. Type II injuries have worse prognosis due to knee joint involvement.

Exam Pearl

Q: What are the associated injuries to evaluate in floating knee?

A: Vascular injury: Popliteal artery (high risk) - check pulses, ABI, consider CT angiography. Knee ligamentous injury: Up to 50% have ligament damage; Assess after skeletal stabilization. Compartment syndrome: High index of suspicion for both thigh and leg. Soft tissue injury: Open fractures common (30-40%). Systemic trauma: Polytrauma evaluation (head, chest, abdomen) due to high-energy mechanism.

Exam Pearl

Q: What is the surgical treatment strategy for floating knee injuries?

A: Damage control: Temporizing external fixation if hemodynamically unstable. Definitive fixation: Both fractures fixed when patient optimized. Femur first: Usually IMN for diaphyseal fractures. Tibia: IMN for shaft; Plates for plateau. Same-day fixation of both fractures preferred to allow early knee mobilization. Early motion critical to prevent knee stiffness.

Exam Pearl

Q: What are the outcomes and complications specific to floating knee injuries?

A: Knee stiffness: Most common complication (20-50%). Malunion/nonunion: Both fracture sites at risk. Infection: Higher rates with open fractures. Vascular injury: Limb-threatening emergency. Long-term outcomes: Return to work only 60-70%. Knee arthrosis: Common in Type II injuries affecting articular surfaces.

Exam Pearl

Q: When should external fixation be used for floating knee injuries?

A: Indications for temporary external fixation: Damage control orthopaedics - polytrauma, hemodynamic instability; Open fractures with severe contamination awaiting soft tissue healing; Vascular injury requiring restoration of length before vascular repair; Compartment syndrome - provides stability during fasciotomy management; Severe soft tissue swelling precluding safe internal fixation. Conversion to definitive fixation typically within 7-14 days when soft tissue and systemic conditions permit.

Australian Context

Epidemiology

Incidence: Higher rates in rural and remote Australia due to high-speed MVAs.
Transport: Prolonged retrieval times in rural settings impact management decisions (Damage Control common).

Trauma System

Major Trauma Centres: Definitive management at Level 1 trauma centres (e.g., Royal Melbourne, Alfred, Westmead).
Retrieval Services: RFDS, CareFlight for rural trauma.

AOA NJRR

The AOA National Joint Replacement Registry tracks outcomes of subsequent arthroplasty required for post-traumatic arthritis.

Guidelines

RACS Position Statement: Polytrauma management protocols.
State Trauma Guidelines: Victoria (VSTORM), NSW (ITIM).

Rehabilitation

TAC/icare: Covers rehabilitation for motor vehicle trauma in VIC/NSW.
NDIS: For patients with permanent disability requiring ongoing support.

Floating Knee Quick Reference

High-Yield Exam Summary

Fraser Classification

•Type I: Both shafts (extra-articular) - best prognosis
•Type IIA: Tibia articular (plateau)
•Type IIB: Femur articular (distal femur)
•Type IIC: Both articular - worst prognosis

Key Assessment

•High-energy polytrauma focus
•Knee ligament injury in 50%+
•Compartment syndrome - thigh AND leg
•Popliteal artery at risk

Fixation Order

•Femur first (restores length/alignment)
•IM nailing preferred for shafts
•Anatomic reduction for articular components
•Damage control if unstable

Complications

•Knee stiffness (most common)
•Ligament instability (often occult)
•Compartment syndrome
•Infection/Nonunion

References

Fraser RD, et al. The floating knee: ipsilateral fractures of the femur and tibia. J Bone Joint Surg Br. 1978.
Rethnam U, et al. Floating knee injuries: a report of 28 cases with management and outcome. Eur J Trauma Emerg Surg. 2007.
Szalay MJ, et al. Associated knee ligamentous injuries in patients with floating knee. J Bone Joint Surg Br. 1990.
Pape HC, et al. Damage control orthopaedics in polytrauma: what's new? Clin Orthop Relat Res. 2002.

Floating Knee Injury

High Yield Overview