Management of Severely Comminuted Open Floating Knee Injuries Using Hinged Ilizarov Frames: A Case Report

Abstract

Floating knee injuries, involving ipsilateral fractures of the femur and tibia, are typically high-energy traumas associated with significant soft tissue damage and poor outcomes. The presence of comminuted, open fractures further complicates management. Traditional internal fixation may not be feasible in such cases, especially when there is risk of infection or soft tissue compromise. The Ilizarov fixator, particularly the hinged construct, provides a viable alternative for limb salvage and functional recovery. We report the case of a 35-year-old male who presented with a gunshot wound causing severely comminuted distal femoral and proximal tibial fractures with hemarthrosis. Clinical and radiographic evaluation confirmed open fractures of the distal femur and midshaft tibia (Gustilo-Anderson type IIIB). Initial management involved aggressive debridement and external stabilization. Due to extensive soft tissue damage and bone loss, definitive fixation was achieved using a hinged Ilizarov external fixator that allowed knee articulation during the healing phase. The patient underwent serial wound inspections, secondary closure, and physiotherapy during follow-up. Radiographic union was achieved, and functional recovery, including partial weight-bearing and knee range of motion, was noted by four months postoperatively. In cases of complex open floating knee injuries with severe comminution and soft tissue involvement, the hinged Ilizarov fixator offers a limb-salvaging option. It enables early joint mobilization, facilitates wound management, and may improve long-term functional outcomes compared to conventional fixation methods in such challenging clinical scenarios.