[The floating joint injury of the lower and upper extremity--epidemiology, therapy and results in 40 extremities].
OBJECTIVE
Floating Joint Injuries (FJI) are resulting from high energy traumas and are often combined with additional neuro/vascular damage. The high incidence of severe open or closed soft tissue injuries is complicating the initial management and requires a broad surgical know-how also in minimal-invasive fixation techniques. In a retrospective analysis of our cases treated between 1980 and 1995, we try to find out some important therapeutical feedback for the future.


METHODS
Of the 37 patients, 33 had a FJI of the lower (2 bilateral) and 7 patients of the upper extremity. 90% were road traffic injuries, 75% showed an open fracture situation and 25% an associated neuro-vascular injury. All fractures were stabilised within the first hours, femur, humerus and forearm in one step, the tibia in 33% in two steps (initial external fixator ...). 80% of the FJI have been reexamined after 1-2 y.


RESULTS
Local complication: Femur: 4/33 (1 infection, 2 refractures, 1 non-union). Tibia: 11/33 (5 infections, 4 delayed/non-unions, 2 malalignements). Humerus: 0/7. Forearm: 1/7 (1 malalignement). 1-2 y-results: Very good-good: Femur: 26/27 (96%). Tibia: 23/27 (85%). Humerus: 4/5. Forearm: 3/5.


CONCLUSIONS
FJI should be stabilised as soon as possible in a way allowing for early functional aftercare of the affected joint. Most complications are observed in the proximal tibia fracture because of the thin and therefore often severely (open or closed) injured soft tissue cover. Despite a staged procedure, there exists a high complication rate, which probably can be reduced in the future by the single-step use of the hybrid external fixateur.
Chirurgische Klinik, Kantonsspital Chur.
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Sommer
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Leutenegger
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T
Rüedi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D001175:Arthrography; D002648:Child; D005260:Female; D005593:Fracture Fixation, Internal; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007596:Joints / Q000293:injuries* / Q000601:surgery; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging / Q000601:surgery*
Die Floating-Joint-Verletzung an der unteren und oberen Extremität--Epidemiologie, Therapie und Resultate bei 40 Extremitäten.