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            [0] => Bilateral floating knee open fracture: A case report.
        )

    [etablissement] => Array
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            [0] => Kassab Institute
        )

    [nom] => Array
        (
            [0] => Masmoudi
        )

    [prenom] => Array
        (
            [0] => Zied
        )

    [email] => Array
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            [0] => masmoudi1994@live.com
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            [0] => 92841784
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            [0] => 
 
Nom prénom / Name Surname: Masmoudi Zied
Email: masmoudi1994@live.com
Hôpital / Hospital: Kassab Institute

 
Nom prénom / Name Surname: Bahroun Sami
Email: samibahroun@ymail.com
Hôpital / Hospital: Kassab Institute

 
Nom prénom / Name Surname: Oueslati Wajih
Email: weslatywajih@gmail.com
Hôpital / Hospital: Kassab Institute

 
Nom prénom / Name Surname: Kacem Samih
Email: kacemmsamih@gmail.com
Hôpital / Hospital: Kassab Institute

 
Nom prénom / Name Surname: Belkahla Karim
Email: drkarimbelkahla@gmail.com
Hôpital / Hospital: Kassab Institute

 
Nom prénom / Name Surname: Daghfous Samir
Email: samir.daghfous@outlook.com
Hôpital / Hospital: Kassab Institute

        )

    [mots_cles] => Array
        (
            [0] => Floating Knee;
Open fracture;
trauma;
External fixator;
nailing;
skin grafts;

        )

    [event-id] => Array
        (
            [0] => 3663
        )

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            [0] => 1
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            [0] => none
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    [user_email] => Array
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            [0] => masmoudi1994@live.com
        )

    [specialite] => Array
        (
            [0] => Chirurgie orthopédique et traumatologique
        )

    [pays] => Array
        (
            [0] => Tunisie
        )

    [texte_abs] => Array
        (
            [0] => Introduction
Floating knee is a rare injury caused by high-energy trauma. It usually presents with other life-threatening injuries and soft-tissue lesions. The functional outcome, and the life of the patient depends largely the therapeutic approach being taken, yet, no standard guideline has been determined so far.
 
Case report
A 30 year-old male presented to the emergency department in a hypovolemic shock, with deformity of both thighs, and extensive soft-tissue loss of the legs.
X-rays showed diaphyseal fractures of the two femurs and tibias, and bodyscan showed skull fractures with no indication for neurosurgery.
Fluid resuscitation and optimization of general condition was done, and fractures were immobilized with external fixation as a dammage control method. The exposed tibias were covered by a gastrocnemius transposition.
After further stabilization in the ICU for one week, antegrade nailing of the femurs was done.
One month later, skin grafts were used to cover the gastrocnemius.
At two months, the wounds were healed, with no signs of infection, x-ray showed good bone healing of the femurs, but no callus in the tibias, so the external fixators were removed with antibiotic coverage for 15 days. After which reaming and antegrade nailing of the tibias was done .
At 6 months, patient was pain-free, ROM was 0/90 on both knees. X-ray showed good callus formation, and full weight bearing was allowed.
 
Discussion
Yokoyama et al also noted that the severity of damage to the knee joint, open tibial fractures and the time delay before definitive fixation were all found to be significant factors contributing to the functional outcome in floating knee injuries.
Initial management of bilateral floating knee should focus on damage control. External fixation can be a fast, definitive treatment but has high rates of non-union. Nailing has the best outcomes, but has high risk of infection when soft tissue is compromised
 
Conclusion
There are a number of methods to treat a floating knee but no single ideal technique. The surgical sequence should be individualized for each patient according to his general condition, to the fracture location and soft tissue status.
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