A Rare Case of Ipsilateral Floating Hip with Femoral Neck Fracture and Contralateral Floating Knee Injury – Proposal for a Management Flowchart and Literature Review

INTRODUCTION: Femoral neck fractures can complicate by non-union and/or hip avascular necrosis (AVN); moreover, the incidence of AVN remains obscure when it is accompanied by an ipsilateral acetabular fracture. Measures to reduce non-union or hip AVN with this complex injury pattern are not well addressed in the literature. CASE REPORT: We report a case of a young male patient who sustained ipsilateral acetabular, femoral neck, and shaft fractures in addition to a contralateral floating knee injury following a motor vehicle collision. To the best of our knowledge, this is the first report that describes the simultaneous occurrence of these fractures and their management. The patient attained an excellent functional outcome with union of all his fractures. We, therefore, propose a management flowchart for this rare case scenario. CONCLUSION: The acute management of ipsilateral femoral shaft and neck fractures in such cases has to be prioritized. The use of a retrograde nail in addition to dynamic hip screw (DHS) with two cannulated anti-rotation screws and locking the DHS to the nail is likely to increase the healing potential of femoral neck fracture in these cases. Acetabular fixation is better to be performed in a second stage after the hyper-inflammation phase ends. The definitive management for the contralateral floating knee can be delayed to a third stage but should be completed within the 10-day limit of immunosuppression.