Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10172-10179
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10172
Simultaneous bilateral floating knee: A case report
Chi-Ming Wu, Hung-En Liao, Shou-Jen Lan
Chi-Ming Wu, Department of Orthopaedic, Jen-Ai Hospital, Taichung 42481, Taiwan
Chi-Ming Wu, Department of Orthopaedic, National Defense Medical Center, Taipei 11490, Taiwan
Chi-Ming Wu, Hung-En Liao, Shou-Jen Lan, Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
Shou-Jen Lan, Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
Shou-Jen Lan, School of Medical Science, Putian University, Putian 351100, Fujian Province, China
Author contributions: Wu CM performed the operation and wrote the manuscript; Lan SJ analysed the clinical data and submitted the manuscript; Liao HE revised the manuscript; All authors approved the final version of this manuscript.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors, including Chi-Ming Wu and Shou-Jen Lan, all declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shou-Jen Lan, PhD, Professor, Department of Healthcare Administration, Asia University, No. 500 Lioufeng Road, Wufeng District, Taichung 41354, Taiwan. shoujenlan@gmail.com
Received: March 23, 2022
Peer-review started: March 23, 2022
First decision: May 31, 2022
Revised: June 30, 2022
Accepted: July 27, 2022
Article in press: July 27, 2022
Published online: October 6, 2022
Processing time: 187 Days and 21.3 Hours
Abstract
BACKGROUND

The phrase “floating knee is a flail knee joint,” referring to ipsilateral femoral and tibial fractures, was first used by Blake and McBryde in 1975. This condition is often caused by a high-energy trauma with often extensive injury to the soft tissues, and is accompanied by life-threatening systemic complications, including head, chest or abdominal injuries and a high incidence of fat embolism. Floating knee is a severe and uncommon injury pattern.

CASE SUMMARY

A 27-year-old man sustained multiple injuries when the electric motorcycle he was riding was hit by a van. His injuries included traumatic hypovolemic shock, comminuted and open type II fractures of the left femoral shaft, fracture of the right femoral shaft, comminuted fracture of the bilateral tibial and fibular shaft, and multiple lacerations and abrasions on his forehead, lower lip, neck and limbs. The diagnosis was simultaneous bilateral floating knee complicated with soft tissue injuries. After emergency treatment and the exclusion of life-threating complications, open reduction and internal fixation were successfully performed using plates and screws in the bilateral femoral and tibial shafts.

CONCLUSION

Simultaneous bilateral floating knee is a rare and severe injury pattern. The treatment is challenging, and complications. We present a case report of a young adult who suffered from bilateral floating knees during road traffic accident. We also offer our treatment experience of this complex injury and review past literature.

Keywords: Floating knee; Femoral and tibial fractures; High-energy trauma; Life-threatening complications; Fat embolism syndrome; Case report

Core tip: Blake and McBryde first used the term floating knee (FK) in 1975. FK often induces severe life-threatening complications, including head injury, intra-abdominal bleeding, vascular rupture, fat embolism syndrome, and acute respiratory distress syndrome. Treatment of FK is challenging. An urgent primary assessment and resuscitation followed by suitable and timely definitive treatment comprising systemic soft tissue and fracture considerations reduces the risk of complications. Simultaneous bilateral FK is extremely rare. We report a case of simultaneous bilateral FK, which included bilateral femoral, tibial, and fibular fractures caused by an electric motorcycle accident, and discuss its therapy process and associated complications.