Polytrauma case Floating knee

1. POLYTRAUMA PATIENT
CASE 02
16.11.2017
Gleb Gavrilkin,
M.D.

2. HISTORY
 20 y.o. male
 7.7.2016 car towards tree accident at
motorway at 6:00 a.m.
 Background not clear, no alcohol / no drugs
 No suicide attempt, no depression
 Normal BMI, no smoking

3. POLYTRAUMA PT
 S06.0 Brain contusion, DAI
 S26.8 Pericard effusion
 S27.0 Pneumothorax traumatica l.sin.
 S62.3 Metacarpal V fracture
 S72.4 Distal femur open fracture l.sin.
 S82.1 Proximal tibial fracture l.sin
 Floating knee

4. FLOATING KNEE, NO NV INJURY
OPEN FEMORAL FX

5. EXTERNAL FIKSATION
- WOUND REVISION
-NO PRIMARY SUTURATION

6. NEUROLOGY
 Convulsing episode in the intensive care unit
 CT: no ICH, no tumors
 Neurologist:
 EEG normal
 MRI scan: DAI + temporal contusion

7. ORIF:
- VA-LCP PLATE
- ASNIS 4MM
-ASNIS 5MM
- NO PLASTIC
SURGERY
NEEDED,
WOUND
SECONDARY
SUTURATION

8. FR. MC V DX

9. CLOSED REDUCTION, K-WIRE FIXATION X 2

10. MALREDUCTION OF FX
-ORIF WITH ANATOMIC PLATE

11. 1 YEAR FOLLOW UP
 Consolidation in tibial and femoral frx
 No crunches needed in mobilisation
 12 degree valgus in mechanical axis,
rotational profile problem
 Severe ankle pain

12. CORRECTION OSTEOTOMY
 8.11.2017:
 VA-LCP plate amotion
 Lateral femoral open wedge osteotomy
with TomoFix plate fixation
 One plane osteotomy, no correction in
femoral torsio

13. POSTOP X-RAYS
 4 degrees
valgus in
mechanical
axis

14. POSTOPERATIVE
 No peroneus irritation
 Full weight of bearing
 Active quadr. Fysiotherapy
 1. follow up in 3 month with X-rays...