Sir,
We read the article titled, “An approach to floating knee injury in Indian Population: An analysis of 52 patients” published in Indian Journal of Orthopedics [1] with keen interest. The author needs compliments for sharing their cases of 52 floating knee injuries and considering cross-legged sitting and squatting as functional outcome modality which is indeed an essential part of daily routine activities in Indian scenario. The contribution of the authors to literature is noteworthy, and we would like to make a few comments about the article.
(1) The incidence of knee pain has been reported as 50% by the authors; however, the authors did not comment on knee injuries and neither on use of any diagnostic modalities such as MRI, intraoperative ligament test or diagnostic arthroscopy, as missed knee ligamentous injury can lead to subsequent knee instability and pain, as this would eventually affect the knee motion and final functional outcome. Paul et al. [2] reported 21 patients with fractures of the ipsilateral femur and tibia, and over 50% of patients suffered from concomitant ipsilateral knee injuries. Szalay et al. [3] compared knee laxity following isolated femur and floating knee injuries. While the incidence was 27% in isolated femur fractures, this almost doubled to 53% in floating knee injuries. Ya Liu et al. [4] in 37 floating knee cases found ligament injuries in 70.3% of patients.
(2) The authors should have mentioned knee pain in 50% patients; however, no further analysis has been done. It would have been more conclusive if authors would have provided group-specific data as per Fraser classification. Literature has shown that type II (a, b, c) fractures are more common to develop knee instability and stiffness and these patients might benefit from MRI prior to surgery which can help to indicate the need for arthroscopy or direct open exploration and repair [5].
(3) The authors have not mentioned the incidence of deep vein thrombosis and no mention has been made on prophylaxis used in the study.
(4) The authors in the study [1] have mentioned opposite lower limb injuries in 7.6% (4 patients) and ipsilateral neck femur fracture in 1.9%(one patient) as depicted in Fig. 4 of Ref. [1], whereas in the discussion sections, the authors have contradicted their own values and mentioned 13.4% (seven patients) with contralateral limb injuries and have mentioned one patient with intertrochanteric fracture instead of neck femur.
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Contributor Information
Subodh Kumar Pathak, Email: drsubodh08@gmail.com.
Rakesh Kumar Gautam, Email: ortho1415@gmail.com.
Jasneet Chawla, Email: jasneetchawla@ymail.com.
Ramesh Chand Jindal, Email: rcjindal19@gmail.com.
References
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