Title: Floating Knee Injuries in a North African Trauma Center: A 9-Year Retrospective Analysis of Epidemiological, Lesional, and Therapeutic Aspects of 52 Cases
Authors: M. Tabti¹, H. Alami Harchali¹, A. Taibi¹, K. Lahrach¹, A. Marzouki¹, F. Boutayeb¹
Volume: 10
Issue: 5
Pages: 83-90
Publication Date: 2026/05/28
Abstract:
Background: The floating knee, defined as the ipsilateral combination of femoral and tibial fractures, is an uncommon but severe injury reflecting high-energy trauma. Published epidemiological data from North African settings remain limited despite the growing regional burden of road traffic trauma. Methods: We conducted a retrospective, single-center, descriptive study of all floating knee injuries managed at the Department of Traumatology and Orthopedics A, Hassan II University Hospital, Fez, Morocco, between January 2017 and December 2025. Demographic, clinical, radiological, therapeutic, and outcome data were extracted from departmental records using a standardized form. The Fraser classification was used for fracture stratification and the Cauchoix-Duparc classification for open fractures. Functional outcomes were assessed using the Karlstr?m-Olerud criteria at last available follow-up (range 6-36 months). Only descriptive statistics were used. Results: Fifty-two patients were included (44 men, 8 women; mean age 29 years, range 16-67). Road traffic accidents accounted for 92.3% of cases, with two-wheeled vehicle accidents representing 59.6%. Polytrauma was present in 25% of cases (mean ISS 22). Open fractures occurred in 71.2% of patients at one or both fracture sites (femur 17.3%, tibia 53.8%). Fraser Type I predominated (71.2%), followed by Type IIa (13.5%), IIb (9.6%), and IIc (5.7%). All patients were managed surgically, with static locked intramedullary nailing used in 39 femoral and 36 tibial fractures. Vascular injury occurred in 11.5% of cases, with two requiring amputation. Secondary complications included infection (9.6%) and fat embolism (1.9%). Late complications included pseudarthrosis (11.5%), joint stiffness (9.6%), and malunion (7.7%). In-hospital mortality was 7.7%, all from refractory hemorrhagic shock within 48 hours of admission. Karlstr?m-Olerud functional outcomes at last available follow-up were excellent or good in 78.8% of cases. Conclusion: The epidemiological and lesional profile of floating knee injuries at our center reflects the regional trauma context, dominated by high-energy two-wheeled vehicle accidents with frequent open fractures. Surgical management with static locked intramedullary nailing remains the reference technique. The complication and mortality profile points to the importance of improving pre-hospital trauma care and standardizing postoperative follow-up.