Acute Management of Combined Floating Hip and Knee Injury: A Case Report

INTRODUCTION: Surgical management of isolated acetabular fracture dislocations, femoral shaft fractures, and tibial shaft fractures are well-documented, but there is limited literature on the acute management of these injuries when they occur concomitantly in the same patient on the ipsilateral extremity. We present a case of the acute treatment of a 33-year-old patient with a right ipsilateral floating hip and knee injury secondary to a motor vehicle accident. We offer a unique surgical technique for the urgent management of this rare combined injury. CASE PRESENTATION: A 33-year-old female presented to our trauma center with an ipsilateral acute posterior wall fracture dislocation, femoral head impaction fracture, femoral shaft fracture, and tibial shaft fracture. After a failed hip reduction attempt in the emergency department, she was urgently brought to the operating room for further management. She underwent percutaneous-assisted schanz pin reduction of the hip, intramedullary nail fixation of the femur and tibia, and dynamic fluoroscopic examination of the hip under anesthesia. CONCLUSION: Successful management of the rare combined floating hip and knee injury requires urgent intervention. The reduction of the hip dislocation is difficult due to the associated injuries. We recommend urgent surgical intervention and the utilization of a percutaneous schanz pin in the proximal femur with gentle manipulation. In most cases, this can effectively reduce the hip without a formal open approach.