Cirugía de Rodilla, Artroscopia y Oncología Ósea: Discusión entre pares / Floating knee / Rodilla Flotante

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Indian Orthopaedic Research

Rahul B Tanga‎Indian Orthopaedic Research Group

35yrs / male presented with floating knee, highly unstable complex c3 type distal femur fracture with closed displaced fracture distal 1 / 3rd tibia. Modified lateral schwashbuckler approach was used to expose distal femur, orif with 6.5mm cc screw fixation done for bilateral hoffas fracture + 8 holed dflcp on lateral aspect with 3.55mm contoured dcp applied on medial side. adequate blood transfusions done pre and post op.

Rahul B Tanga Valuable inputs?
Ayer a las 0:43 · Me gusta

Ranjan Mohan G8 work!!
Ayer a las 0:48 · Me gusta · 1

Aashish Suthar Great work Rahulbhai.....hats off
Ayer a las 0:50 · Me gusta · 1

Aashish Suthar May I keep this photos for reference ? ????
Ayer a las 0:51 · Me gusta · 1

Surendra Patil Great job
Ayer a las 0:52 · Me gusta · 1

Balakannan Jayabalan
Ayer a las 0:54 · Me gusta · 1

Subhash Shalya gud job done really
Ayer a las 0:55 · Me gusta · 1

Vivek Barot

Ayer a las 1:00 · Me gusta

Gamil Baghdady Nice but why not ilizarov
Ayer a las 1:00 · Me gusta · 1

Golam Mahmud Suhash Excellent
Ayer a las 1:05 · Me gusta · 1

Naeem Hassan What about patella?
Ayer a las 1:07 · Me gusta · 1

Mohammad Tahir Suberb work .excellent approach
Ayer a las 1:07 · Me gusta · 1

Naeem Hassan May patella glide as screws heads are there
Ayer a las 1:08 · Me gusta · 1

Jayant Sharma I keep the condylar screws 10mm shorter to avoid penetration.
Ayer a las 1:10 · Me gusta · 1

Naeem Hassan Any ligament injury
Ayer a las 1:10 · Me gusta

Jayant Sharma Can cancellous screws be used, instead of fully threaded. For controlled compression.
Ayer a las 1:14 · Me gusta · 1

Drvinod Rajkumar Excellent work sir
Ayer a las 1:19 · Me gusta

Manish Choksi rahul nice work.
keep us update regarding follow up.
Ayer a las 1:19 · Me gusta · 2

Manish Choksi what is your post op plan for this pt.
Ayer a las 1:21 · Me gusta · 1

Naeem Hassan 16 threaded screws with washers better
Ayer a las 1:22 · Me gusta

Rashid G Mohamed well done. ..nice job
Ayer a las 1:33 · Editado · Me gusta · 1

Naeem Hassan Gud job - articular surface maintained
Ayer a las 1:27 · Me gusta · 1

Zaky Basuony Good job
Ayer a las 1:28 · Me gusta · 1

Nirmal Chaudhari Well done
Ayer a las 1:31 · Me gusta · 1

Fareed Alsudany Good job
Ayer a las 1:31 · Me gusta · 1

Sayed Elsibaey Great effort sir ... congratulations
Ayer a las 1:43 · Me gusta · 1

Anshu Anand Fantastic Sir !!
Ayer a las 1:44 · Me gusta · 1

Mohsin Kazi Excellent
Ayer a las 1:49 · Me gusta · 1

Abdelrahman Eldiasty Dear colleague
I have some concerns
Reduction of hoffa fr, was really good.. hats off
BUT
1 too much un-needed proximal dissection and stripping of periosteoum.
2 why is the need for a second plate?
For the above two reasons I am concerned about the soft tissue dissection and later healing. Yes pxrs are v good and according to tge AO philosophy. We are treating pts. Not pxrs.
3 last I don't think this is a floating knee.... I am attaching a link about floating knee definition
http://emedicine.medscape.com/article/1249181-images...
Thanks
I am interested for followup of this pt.

Floating Knee
Floating Knee. Floating knee is a flail knee joint resulting from fractures of the shafts or adjacent...
EMEDICINE.MEDSCAPE.COM
Ayer a las 2:00 · Me gusta · 9

Prakshay Agarwal Great job
Ayer a las 2:04 · Me gusta · 1

Prasad Murugappa Gowda Great job...
Ayer a las 2:04 · Me gusta · 1

DrPookhraj Choudhary Great job really best . bone grafting done or not
Ayer a las 2:07 · Me gusta · 2

Rami Hussein Very good. I see you nailed the tibia first, I may in this case have plated the tibia as an exception to the general rule. Well done.
Ayer a las 2:08 · Me gusta · 1

Ahmad Alssayegh Rahul B Tanga Brave work really .
2 queries :
- which # did you fix first & why ?? . it seems that you fixed the tibia 1st !!?
- the op period ??
Ayer a las 2:14 · Me gusta · 1

Kamal Tolani Excellent
Ayer a las 2:14 · Me gusta · 1

Ahmed Ramy Excellent xray
But too much soft tissue stripping
Ayer a las 2:16 · Me gusta · 4

Rudwan Turkman Splendid
Ayer a las 2:21 · Me gusta · 1

Gursimrat Singh Cheema Nice job done. .
May wound heal well
Ayer a las 2:24 · Me gusta · 1

Murtaza Fazal Ali Good job
Ayer a las 2:26 · Me gusta · 1

Papanaik Haridas Great job for this type of complicated intraarticular fractures.
Ayer a las 2:35 · Editado · Me gusta · 2

Kunal Bansal nice reduction sir but a question to me is why did you use the medial plate ? would it be enough to use a single plate?
Ayer a las 2:34 · Me gusta · 3

Younis Kamal Too much dissection
Worrying me a lot
Gaurded prognosis
Ayer a las 2:37 · Me gusta · 3

Rahul B Tanga Naseem patella is normal
Ayer a las 2:55 · Me gusta

Santosh Soni excellent exposure & reduction sir .
Ayer a las 2:56 · Me gusta · 1

Rahul B Tanga Abdelrahman Eldiasty thanks . anatomical Articular reduction is must in such cases and had to extend incision proximally so some amount of soft tissue dissected and there was internal compounding seen as shaft of femur had torn quadriceps medially and was jetting out.second plate is required as it's highly unstable type c3 and medial plate avoid early varus collapse.at the same time it was not possible to pass adequate number of screws through dflcp upto medial condyle due to hoffas screw so had to add medial plate and screw and if you go through literature and has been mentioned use of two implants in such cases.i think you are new this forum and all possible fractures have been treated by me and shown excellent results with my approach. Anatomical reduction is must in such cases and do not agree with you .It's a floating knee and kindly go through the literature properly.
Ayer a las 3:04 · Me gusta · 6

Rahul B Tanga DrPookhraj Choudhary primary bg done.
Ayer a las 3:05 · Me gusta · 1

Rahul B Tanga Dr Ahmad Alssayegh first tibia mailing was done keeping in mind that it will aid reduction for femur as longitudinal traction can be given.after fixing such complex femur then nailing was scared whether femur will get disturbed.
Ayer a las 3:13 · Me gusta · 1

Rahul B Tanga Thanks Kunal Bansal I have answered in my previous long comment
Ayer a las 3:15 · Me gusta

Srinivas Daravathu nice work Rahul B Tanga,is ACL ok?i dont think we can go dual plating with limited approach using only part of swashbuckler app? wat do u say?
Ayer a las 3:19 · Me gusta · 1

Ananda Regmi Great job
Ayer a las 3:23 · Me gusta · 1

Rahul B Tanga I agree with you srinivas. Acl is Ok. For dual plating adequate exposure is required. If you compromise with exposure in such case then you will be compromising with reduction and fixation.
Ayer a las 3:35 · Me gusta · 4

Kuldeep Malik A new example of Dr Tanga's excellent work , congrats Dr rahul nice job done.
Ayer a las 3:37 · Me gusta · 1

Kunal Bansal agreed sir ! thanx for clarification!
Ayer a las 3:39 · Me gusta · 2

Neeraj Singh Good job Dr Rahul good exposure and fixation medial plate is necessary in this case
Ayer a las 3:43 · Me gusta · 1

Harish Makker excelllent as always......
Ayer a las 3:48 · Me gusta · 1

Rajendra Prasad Very good reduction and fixation.
But I ussually avoid this much dissection.
Ayer a las 3:54 · Me gusta · 2

Rajendra Prasad

Ayer a las 3:56 · Me gusta · 1

Rohit Damor Great work... Rahul B Tanga
Ayer a las 3:57 · Me gusta · 1

Rajendra Prasad

Ayer a las 3:57 · Me gusta · 2

Rajendra Prasad

Ayer a las 3:58 · Me gusta · 1

Shrinivas Kalliguddi Nice work Rahul B Tanga and Rajendra Prasad
I think some soft tissue could have been conserved proximally..
Ayer a las 4:20 · Me gusta · 1

Bibek Basukala great work, inspiration to rookies like us......
Ayer a las 4:21 · Me gusta · 1

Paras Gupta You have done your job in excellent way rest will be managed by nature itself
Ayer a las 4:27 · Me gusta · 3

Sagar Chhetri Great job.......
Ayer a las 4:31 · Me gusta · 1

Prashanth GA Gowda nice reduction
Ayer a las 4:52 · Me gusta · 1

Hassan Fajr Nice reduction.it is my monograph document
Ayer a las 5:01 · Me gusta · 1

Gautam Chandrapaul Good job
Ayer a las 5:08 · Me gusta · 1

Jasjot Singh Well done
Ayer a las 5:14 · Me gusta · 1

Arvind Verma Jangid Good job Rahul B Tanga
Ayer a las 5:17 · Me gusta · 1

Umer Zeb Khan Sir You have done GREAT JOB
Ayer a las 5:21 · Me gusta · 2

Said Abdelhaleem Great job
Ayer a las 5:28 · Me gusta · 1

Pramod Lamichhane Too much stripping proximally. .otherwise excellent reduction.
Ayer a las 5:36 · Me gusta · 1

Chetan Umarani Very nice
Ayer a las 5:39 · Me gusta · 2

Abdelrahman Eldiasty Rahul B Tanga dear sir
I believe I have gone through the literature properly!!!
I gave a link for what I found.
Could you please support your work with a link. I would be happy to learn from you.
Kindly justify with evidence.
Thanks
Ayer a las 5:44 · Me gusta · 1

Abdelrahman Eldiasty Regarding
1 the def of floating knee
2 I will search double plating for the distal femur too.
Ayer a las 5:45 · Me gusta

Bhupesh Mahawar Excellent Rahul, what else to say,,
Yes party to banti hai...
Ayer a las 5:46 · Me gusta · 1

Ismail Khalid Kattawi Excellent job
Ayer a las 5:51 · Me gusta · 1

Vikrant Ghanwat excellent ..nice fixation
Ayer a las 5:56 · Me gusta · 1

Mahmoud Bakri Good job .
Ayer a las 5:57 · Me gusta · 1

Ashraf Goda Good reduction but agressive stripping of soft tissues...bold bone
Ayer a las 6:01 · Me gusta · 2

Varun Chouhan Perfect
Ayer a las 6:41 · Me gusta

Rajoo Kumar Nice work...medial plate not well contoured
Ayer a las 6:55 · Me gusta

Shriniwas Sandikar Good job.
Ayer a las 7:25 · Me gusta · 1

Hanume Gowda S N Rahul very good job yet again....you always cross conventional borders to achieve good results.....
Dual plating is accepted and regularly done procedure for such fractures....
Ayer a las 7:26 · Me gusta · 4

Abdelrahman Eldiasty That is what I found...still I believe evidence based. Too early to be generalized.
And nothing I could find about this on AOTrauma as well.
Good luck any way

Ayer a las 8:42 · Me gusta

Abdelrahman Eldiasty Not evidence based I meant
Ayer a las 8:43 · Me gusta · 1

P Sudhir Kumar Really this shows Doctor is next to God. Rahul saab, Hat's off. Great work
Ayer a las 8:52 · Me gusta · 1

Meewangyal Yolmo U r an artist man. Beautifully visioned and applied.
Ayer a las 9:04 · Me gusta · 1

Freddy F Galvis Gomez EFreddy F Galvis Gomez EXCELENT COMENTS :""plate is required as it's highly unstable type c3 and medial plate avoid
early varus collapse.at the same time it was not possible to pass
adequate number of screws through dflcp upto medial condyle due to
hoffas screw so had to add medial plate and screw and if you go through
literature and has been mentioned use of two implants in such cases!!.EXCELENT SUPPORT FOR ITS CASE:"
Ayer a las 9:08 · Me gusta · 4

Aditya Sadawarte Very nice fixation. .
Ayer a las 9:14 · Me gusta · 1

Prashant Patare Good job.
Ayer a las 9:47 · Me gusta · 1

Bahaa Mohammed I am really happy for this fruitful discussion
Ayer a las 10:00 · Me gusta · 2

Sandeep Kesharwani Great job
Ayer a las 10:02 · Me gusta · 1

Tarek Elsaidy Very very excellent good jop
Ayer a las 10:07 · Me gusta · 1

Tarek Elsaidy Thanks prf. Raul.
Ayer a las 10:08 · Me gusta

Naji Kareem well done
Ayer a las 10:21 · Me gusta · 1

Bahaa Mohammed Pls for follow up
Ayer a las 10:26 · Me gusta · 1

Ariadna Ruvalcaba Excelente cirugia Felicidades
Ayer a las 10:37 · Me gusta · 1

Harsha Kumar Koramutla Excellent work
Ayer a las 10:51 · Me gusta · 1

Gaber Eid Nice.. with close f.up
Ayer a las 10:55 · Me gusta · 2

Kiran Saoji Fantastic
Ayer a las 11:44 · Me gusta · 1

Abhijeet Mahadar Good job!
Ayer a las 12:05 · Me gusta · 1

Bibek Rai Nice artistic job..
Ayer a las 12:36 · Me gusta · 2

Jay Deep Ghosh One of the best cases seen.
Ayer a las 12:40 · Me gusta · 1

د.محمد سعيد Well done
But why u dont bend the medial plate more to come with bone contour?!
Ayer a las 12:49 · Me gusta · 2

Kawa M. Ibrahim Well done....
Ayer a las 12:54 · Me gusta · 1

Ashraf Goda The approach memic to TkR
But extended upward violatin quadriceps and distaly medial to patellar lig to permit a portal for interlocking tibial nail with patellar dislocation ....
What about extensor mechanism?
Ayer a las 13:03 · Me gusta · 1

Daya Krishna Good job..good intentions.
Ayer a las 13:13 · Me gusta

Ahmed Abdelnaby Morad Omar Morad
Ayer a las 13:37 · Me gusta · 1

Morad Omar Morad Good job
But your approach is less invasive Ahmed Abdelnaby I think
Ayer a las 13:40 · Me gusta

Vaibhav Ahuja Very well done sir!!! Cases like these are an invaluable learning experience.
Thanks for sharing
Ayer a las 14:20 · Me gusta · 1

Praneethchowdary Jagarlamudi One of the best surgery
Ayer a las 14:23 · Me gusta · 1

Sukhvinder Singh Basran Well done !
23 horas · Me gusta · 1

Manikandan Jeyaprakash Wonderful surgical demo, great work Rahul, keep going
23 horas · Me gusta · 1

Ramesh Kumar Gupta Excellent
20 horas · Me gusta · 1

Rahul B Tanga Thanks everyone for your valuable inputs and support.
20 horas · Me gusta · 2

Vanteru Kishore Chandra Reddy Excellent
19 horas · Me gusta · 1

Ashwini Gaurav Another feather in your cap Sir.... Just amazing !! You should post your operation videos as tutorials Thanks for sharing.
14 horas · Me gusta · 1

Rahul B Tanga Thanks Ashwini Gaurav.
14 horas · Me gusta

Salik Imam agree with ashwini.............
11 horas · Me gusta · 1

Ram Jadhao small request to iogr......change group name to rahul sir.... its amazing as usual... kamaal hai sirji...
11 horas · Me gusta · 1

Ram Jadhao dn mind dear iogr... its jst a reaction being constant follower n admirer of rahul sir.... thanx.
10 horas · Me gusta · 1

Rami Hussein I like the professionalism of the colleagues in this group. Please keep it that way. Regards to all.
10 horas · Me gusta · 1

Kir Pat Rahul ,Good work ,,only one comment abt approach, you have dissected periosteal too far proximally which could have been minimised
10 horas · Me gusta · 3

Rahul B Tanga Thanks Dr kir pat.ya I agree with you and other members.i was bit tensed on table and later realised the dissection.will avoid it next time.thanks
10 horas · Me gusta · 7

Pramod Mehta dear rahul after such extensive stripping of bone dont u fear of bone necrosis or nonunion or osteomylytis any past experience?
8 horas · Me gusta · 2

Hemant Koujalgii Excellent job Rahul, you have given your best don't bother about post op. mobilse early
8 horas · Me gusta · 2

Pavan Patil excellent , like to come and visit ur hospital rahul , u have giffted hand and good vision
8 horas · Me gusta · 1

Rahul B Tanga Dear dr pramod mehta I have operated some of the cases where bone fragments were brought in polythene bag by attenders and had put them back into place with BG.i don't fear of infection , bone necrosis and osteomyelitis Thanks I strictly follow principles of wound debridement , fixation and do dissect tissue in a systematic way and wound closed in layers with multiple drain in situ and delayed drain removal.
7 horas · Me gusta · 4

Rahul B Tanga Thanks Hemant.ya planning to start rom after drain removal.
7 horas · Me gusta

Rahul B Tanga Thanks a lot for nice lines Pavan.i stay 150km from your place. Most welcome it will be pleasure meeting you.
7 horas · Me gusta · 1

Pavan Patil thanks Rahul
7 horas · Me gusta · 1

Rahul B Tanga