Floating knee: modification on the Fraser classification and factors associated with functional results
DOI:
https://doi.org/10.1016/j.rccot.2020.07.008Keywords:
floating knee, classification, trauma, functional outcomes, correlationAbstract
Background: Floating Knee is due to high energy trauma, with high rates of complications and multiple patterns of fractures. A modification of the Fraser Classification is introduced, and identifies factors associated with functional outcomes.
Methods: An ambidirectional cohort study was conducted in a referral teaching hospital during 2008 and 2012. Demographic variables, vascular lesion, infection, and open fractures were recorded. A modification of the Fraser Classification was used to classify the fractures. The Modified Fraser Classification (MFC) encompasses the following distribution: Type I, Type II A, Type II B, and Type II C, and Type III A, Type III B, and Type III C, was added. The correlation between functionality and the MFC was assessed. The Karlstrom and Olerud criteria were used to determine the functional outcome.
Results: A total of 34 patients were included, of whom 30 (80%) were males and 4 (12%) females. The mean age was 32 years ± 10.3. According to the MFC, the Type II A (n = 15 - 44%) and Type I (n = 13 - 38%) were the most common. The functionality outcomes of the patients were Excellent in 50% (17), Good in 9% (3), Acceptable in 15% (5), and Poor in 26% (9). There was a moderate correlation between poor outcomes and the Modified Fraser Classification (rho = 0.42, P = 0.046). Age ≥ 40 years (OR 6.7, 95% CI; 1.1 - 41, P = 0.03) and infection (OR 7.2, 95% CI; 1.5 - 33, P = 0.01) were associated with acceptable/poor results.
Discussion: The Modified Fraser Classification includes more patterns of fractures in comparison with the original Fraser Classification, allowing for a better characterisation of the patients, with moderate correlation with functional outcomes. Age ≥ 40 years and infection were associated with an acceptable/poor result.
Evidence level: III
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