Single Incision Nailing of the Floating Knee Do We Ignore
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International Orthopaedics (SICOT) (2006) 30: 311 DOI 10.1007/s00264-006-0107-x LETTER TO THE EDITOR U. Rethnam Single incision nailing of the floating knee—do we ignore the knee ligaments? Received: 13 December 2005 / Accepted: 13 December 2005 / Published online: 11 April 2006 # Springer-Verlag 2006 Abstract The incidence of knee ligament injuries in the floating knee is as high as 53% documented in the lit- erature. The single incision technique (antegrade tibial and retrograde femoral nailing through a single incision at the knee) although a good technique in terms of speed and ease, has its own disadvantages. Repair or reconstruction of a torn anterior or posterior cruciate ligament after a single incision technique can be a difficult proposition. Antegrade femoral and tibial nailing (two incisions) makes treatment of knee ligament injuries easier. I read with great interest the article titled “Management of ipsilateral femoral and tibial fractures” (International Orthopaedics Aug 2005;29(4):245–250). The “single incision” femoral and tibial nailing does have the advantage of being a quick and easy method of fixation of this difficult injury. There is however, a major drawback to this technique which I would like to point out. It is well documented in the literature that Floating Knee injuries have a higher incidence of knee ligament injuries as compared to isolated femoral or tibial fractures. The incidence of knee ligament injuries can be as high as 53% according to studies [1, 2]. The most common injury is an anterior cruciate ligament tear [2] with posterior cruciate ligament, meniscal and collateral ligament injuries follow- ing suite. Pre-operative diagnosis of these injuries is dif- ficult as the floating knee injury itself is a “distracting injury” and the inability to perform a proper clinical ex- amination of the knee in the presence of fractures in the same limb. With the “single incision” technique, repair or recon- struction of a torn anterior or posterior cruciate ligament is a difficult proposition. I feel after an antegrade femoral and tibial nailing of a floating knee, the treatment of knee ligament injuries is easier. After surgical stabilisation of the fractures, the ipsilateral knee is assessed for any evidence of instability under the same anaesthesia. Any instability detected can be dealt with at the same time. Moreover, the authors of the study have obtained results similar to studies where antegrade femoral nailing was done. Therefore the “single incision” technique for the treat- ment of the floating knee injury has its own advantages and disadvantages. References 1. Paul GR, Sawka MW, Whitelaw GP (1990) Fractures of the ipsilateral femur and tibia: emphasis on intra-articular and soft tissue injury. J Orthop Trauma 4(3):309–314 2. Szalay MJ, Hosking OR, Annear P (1990) Injury of knee liga- ment associated with ipsilateral femoral shaft fractures and with ipsilateral femoral and tibial shaft fractures. Injury 21(6):398– 400 This comment refers to the article available at: http://dx.doi. org/10.1007/s00264-005-0661-7. U. Rethnam Clinical Research Fellow Orthopaedics, Wrexham Maelor Hospital, Wrexham, UK U. Rethnam (*) 18 Bron Y Nant, Croesnewydd road, LL13 7TX Wrexham, UK e-mail: [email protected]Tel.: +447779095559
Single Incision Nailing of the Floating Knee Do We Ignore
InternationalOrthopaedics(SICOT) (2006) 30: 311DOI
10.1007/s00264-006-0107-xLETTERTOTHEEDITORU. RethnamSingle incision
nailing of the floating kneedo we ignorethe knee
ligaments?Received:13 December 2005 / Accepted: 13 December2005 /
Published online:11 April 2006# Springer-Verlag 2006Abstract
Theincidenceofkneeligament injuriesinthefloatingkneeis as highas
53%documentedinthelit-erature. The single incision technique
(antegrade tibial andretrograde femoral nailing through a single
incision at theknee) althoughagoodtechniqueintermsof speedandease,
has its own disadvantages. Repair or reconstruction ofa torn
anterior or posterior cruciate ligament after a singleincision
technique can be a difficult proposition. Antegradefemoral and
tibial nailing (two incisions) makes treatmentof knee ligament
injuries easier.I read with great interest the article titled
Management ofipsilateral femoral and tibial fractures
(InternationalOrthopaedics Aug 2005;29(4):245250).The
singleincisionfemoral andtibial
nailingdoeshavetheadvantageofbeingaquickandeasymethodoffixation of
this difficult injury. There is however, a majordrawback to this
technique which I would like to point out.It is well documented in
the literature that Floating Kneeinjuries have a higher incidence
of knee ligament injuriesas comparedtoisolatedfemoral or tibial
fractures. Theincidence of knee ligament injuries can be as high as
53%according to studies [1, 2]. The most common injury is
ananteriorcruciateligament tear[2]withposteriorcruciateligament,
meniscal and collateral ligament injuries follow-ingsuite.
Pre-operativediagnosisoftheseinjuriesisdif-ficult as
thefloatingkneeinjuryitself is a
distractinginjuryandtheinabilitytoperformaproperclinical
ex-aminationofthekneeinthepresenceoffracturesinthesame
limb.Withthesingleincisiontechnique, repair or recon-struction of a
torn anterior or posterior cruciate ligament isa difficult
proposition. I feel after an antegrade femoral andtibial nailingof
a floatingknee, the treatment of kneeligament injuries is easier.
After surgical stabilisation of thefractures, the ipsilateral knee
is assessed for any evidenceofinstabilityunderthesameanaesthesia.
Anyinstabilitydetected can be dealt with at the same time.
Moreover, theauthors of the study have obtained results similar to
studieswhere antegrade femoral nailing was
done.Thereforethesingleincisiontechniqueforthetreat-ment of the
floating knee injury has its own advantages
anddisadvantages.References1. Paul GR, SawkaMW, WhitelawGP(1990)
Fracturesof theipsilateral femur and tibia: emphasis on
intra-articular and softtissueinjury. J Orthop Trauma 4(3):3093142.
Szalay MJ, Hosking OR, Annear P (1990) Injury of knee liga-ment
associated with ipsilateral femoral shaft fractures and
withipsilateralfemoralandtibialshaftfractures.Injury21(6):398400This
comment refers to the articleavailable at:
http://dx.doi.org/10.1007/s00264-005-0661-7.U.
RethnamClinicalResearch FellowOrthopaedics,WrexhamMaelor
Hospital,Wrexham, UKU. Rethnam (*)18 Bron Y
Nant,Croesnewyddroad,LL13 7TX Wrexham,
UKe-mail:[email protected].: +447779095559
