management of floating knee

LETTER TO THE EDITORManagement of floating kneeAnil Kumar Joshi & Saurabh Singh & Vivek TrikhaReceived: 15 January 2007 / Revised: 19 January 2007 / Accepted:21 January 2007 / Published online:3 February 2007# Springer-Verlag 2007Dear Editor,We have read with great pleasure the article entitledIpsilateral fracturesof tibiaandfemur or floatingknee[1]. We would like to congratulate the authors forevaluatingtheissueverywell. Theyhavedefinitelymadea great contribution to the relevant literature on intra-medullary(IM) nailing. IMnailinghas becomethegoldstandard to stabilise these fractures in immediate or delayedsettings[2].Wewouldliketosaythatitisaneraoflimbdamagecontrol orthopaedics, which must be considered whendealingwithpolytraumapatients.Duringthe1990sitwasadvocated that the adverse outcome of fracture surgery,especiallyIMnailing, hadsystemic physiological effectsknown as second-hit phenomena. A major concern beingto decrease second-hit phenomena, a more selectiveapproach to fracture fixation was used; however, earlyfixationwasstill performedinmost cases. Thisphenom-enon,whichparticularlyincreaseswithreamedIMnailingin polytrauma patients, results in increased chances ofpulmonary complications[3, 4].We would like to drawthe authors attentiontothe factthattheyhavenotmentionedtheapproachforIMnailing.Wesuggest useof asinglelongitudinal incisionover thekneeforretrogradenailingoffemurandantegradenailingtibiainasinglesessionwiththeadvantageofdecreasingtheoperativetimeandmorbiditywhileobtainingequallygood results [5].References1. Elmrini A, Elibrahimi A, Agoumi Oet al (2006) Ipsilateralfracturesoftibiaandfemurorfloatingknee. Int Orthop30:325328 DOI 10.1007/s00264-006-0084-02. Craig SR, Pape HC et al (2005) J Bone Jt Surg Am 87:4344493. Giannoudis PV, Smith RMet al (1999) Stimulation of theinflammatorysystembyreamedandunreamednailingoffemoralfractures. An analysis of the second hit. J Bone Jt Surg Br 81:3594. Ribet ME(1994)Damagecontrolintraumasurgery. BrJSurg81:6275. RobertWB,JamesDH(1994)Fracturesinadults.Vol.3,5thedn.41:17051706International Orthopaedics (SICOT) (2007) 31:271DOI 10.1007/s00264-007-0328-7A. K. Joshi: S. Singh:V. Trikha (*)Department of Orthopaedics,All India Institute of MedicalSciences,New Delhi, Indiae-mail: vivektrikha@rediffmail.com