Lundy D W, Johnson K D
Orthopaedic Trauma Service, Orthopaedic Center of the Rockies, Fort Collins, CO 80525, USA.
J Am Acad Orthop Surg. 2001 Jul-Aug;9(4):238-45. doi: 10.5435/00124635-200107000-00003.
Ipsilateral fractures of the femur and tibia have been called "floating knee" injuries and may include combinations of diaphyseal, metaphyseal, and intra-articular fractures. These are often high-energy injuries and most frequently occur in the polytrauma patient. Many of these fractures are open, with associated vascular injuries. Surgical stabilization of both fractures and early mobilization of the patient and the extremity produce the best clinical outcomes. The use of a radiolucent operating room table and the introduction of retrograde intramedullary fixation of femoral fractures have facilitated surgical stabilization of some floating-knee fracture patterns. Although treatment planning for each fracture in the extremity should be considered individually to achieve the optimal result, the effect of that decision must be considered in light of the overall injury status of the entire extremity. Collateral ligament and meniscal injuries may also be associated with this fracture complex. Complications (such as compartment syndrome, loss of knee motion, failure to diagnose knee ligament injury, and the need for amputation) are not infrequent. Better results and fewer complications are observed when both fractures are diaphyseal than when one or both are intra-articular.
同侧股骨和胫骨骨折被称为“浮动膝”损伤，可能包括骨干、干骺端和关节内骨折的组合。这些通常是高能量损伤，最常发生于多发伤患者。其中许多骨折为开放性骨折，并伴有血管损伤。对两处骨折进行手术固定以及患者和肢体的早期活动可产生最佳临床效果。使用可透射线的手术台以及采用股骨骨折逆行髓内固定术有助于某些浮动膝骨折类型的手术固定。尽管为实现最佳效果应分别考虑肢体中每处骨折的治疗方案，但该决策的效果必须根据整个肢体的整体损伤状况来考虑。侧副韧带和半月板损伤也可能与这种骨折复合体相关。并发症（如骨筋膜室综合征、膝关节活动丧失、未能诊断出膝关节韧带损伤以及需要截肢）并不少见。与一处或两处为关节内骨折相比，两处均为骨干骨折时效果更好且并发症更少。
