PMC5974666_01
Computed tomographyscout shows the floating knee IIB according to Fraser.
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F1
At 4:30 am, a 23-year-old patient arrived at our drug enforcement administration, after a high kinetic energy car accident (car against the wall) in orotracheal intubation with a Glasgow coma scale (GCS) of 11/15, mangled extremity severity score 4 points for the femur, and 3 points for the leg, and an injury severity score of 24 points:oderate concussion, moderate splenic ulcerations, supra-intercondylar fracture of the femur (3.3-C1 according to AO) left exposed Gustilo Anderson (GA) IIIB and bone loss of the metaphyseal area >50% and shaft fracture(Fig. 1 and 2) with a third fragment (4.2- B2 according to AO) exposed GA 3B(Fig. 1).
Intr operative fluoroscopy showing bone loss more than 50% at the metashaft distal of the left femur.
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F2
At 4:30 am, a 23-year-old patient arrived at our drug enforcement administration, after a high kinetic energy car accident (car against the wall) in orotracheal intubation with a Glasgow coma scale (GCS) of 11/15, mangled extremity severity score 4 points for the femur, and 3 points for the leg, and an injury severity score of 24 points:oderate concussion, moderate splenic ulcerations, supra-intercondylar fracture of the femur (3.3-C1 according to AO) left exposed Gustilo Anderson (GA) IIIB and bone loss of the metaphyseal area >50% and shaft fracture(Fig. 1 and 2) with a third fragment (4.2- B2 according to AO) exposed GA 3B(Fig. 1).
(a, b) Bridging knee external fixation for damage control.
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F3
The patient was treated in emergency with a bridge femorotibial external fixator after extensive cleaning and debridement of open fractures(Fig. 3a and b).
X-rayspost-operative shows the reduction and fixation of fracture and bone loss with external metal plate and screws and medial allograft bone strut.
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F4
The surgical access chosen was the lateral subvastus to preserve the perforating arteries(Fig. 4).
The X-rays (A and B) follow-up at 3 months shows good bone consolidation processes of the femur, poor tibial (C and D). Intramedullary nailing of tibial shaft at 3 months after injury (E and F).
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F5
The patient was subjected to the intervention of removal of the external fixator and intramedullary nailing of the tibia 3 months after the first surgery(Fig. 5).
Excellent functional recovery 48 months after injury.
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F6
At follow-up at the past 36 months, a year after the removal of plaque and nail, the patient showed KOOS 100 points, a SF-36 out of 100 points(Fig. 6), and R.U.S.T and R.U.S.T 4 out of 4 points(Fig. 7).
The X-rays shows the perfect consolidation and the femur bone regeneration.
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F7
At follow-up at the past 36 months, a year after the removal of plaque and nail, the patient showed KOOS 100 points, a SF-36 out of 100 points(Fig. 6), and R.U.S.T and R.U.S.T 4 out of 4 points(Fig. 7).