The floating knee in the pediatric patient : Nonoperative versus operativestabilization

The results of nonoperative and operative or rigid stabilization of ipsilat eral femur and tibia fractures in children and adolescents were evaluated. Twenty-nine consecutive patients with open physes (30 affected extremities) were reviewed. Their mean followup was 8.6 years (range, 1.1-18.6 years). The nonoperative group consisted of 16 patients and 16 extremities treated by skeletal traction of the femoral fracture, closed reduction and splintin g or casting of the tibia fractures, and eventual immobilization in a hip s pica cast. The operative group, was comprised of 13 patients and 14 extremi ties in which one or both fractures were treated by open reduction and inte rnal fixation, intramedullary fixation, or external fixation. Despite highe r modified injury severity scores and skeletal injury scores, the patients who were treated operatively had a significantly reduced hospital stay, 20. 1 days versus 34.9 days, respectively; decreased time to unsupported weight bearing, 16.8 weeks compared with 22.3 weeks, respectively; and fewer compl ications. Operative stabilization of the femur had a significant effect on decreasing the length of hospital stay and the time to unassisted weightbea ring. The patients also were analyzed according to their age at the time of injury: 9 years of age or younger and 10 years of age and older. The young er children who were treated nonoperatively had an increased rate of lower extremity length discrepancy, angular malunion, and need for a secondary su rgical procedure: as compared with younger children who were treated operat ively with rigid fixation. Based on the results of the current study, opera tive stabilization of at least the femur fracture and, preferably, both fra ctures in the treatment of a child with a floating knee is recommended, eve n for younger children.