Open pelvic ring fracture with floating hip and knee: A case report

Abstract

Open pelvic ring fractures are rare injuries typically resulting from high-energy trauma, often leading to significant morbimortality. The simultaneous occurrence of an ipsilateral floating hip and knee is rare, with no prior reports in literature of all three conditions coexisting. These are prone to severe complications due to the rich blood supply in the pélvis and femur, causing substantial blood loss and potentially leading to traumatic shock, retroperitoneal haematoma, and organs damage. Despite classification systems for these injuries and established treatment protocols for individual fractures, their collective occurrence presents significant clinical challenges. This report discusses a polytrauma case featuring an open pelvic fracture with floating hip and knee.A 22-year-old obese male with no significant medical history was involved in a high-energy motorcycle accident. In the emergency room, he was conscious but agitated and had stable vitals. He had a significant wound in the left inguino-scroto-perineal region and right lower limb deformity. Diagnostic imaging revealed a complex pelvic ring fracture, a segmental fracture of the right femoral shaft, and an open fracture of the right leg. A damage control strategy was started, with reduction and stabilization of the pelvic and lower limb fractures. The patient underwent multiple surgical procedures, including external fixation and intramedullary nailing. Postoperatively, he was stable and transferred to the Intensive Care Unit. The evolution was good, and he was discharged on the 36th postoperative day. At 12 months post-op, he displayed full functionality, no pain, and no neurovascular or genito-urinary impairments.These injuries are uncommon. Stabilizing with an external fixator over a C-clamp may yield better outcomes for Tile B1 fractures. Excessive resuscitation can exacerbate hypothermia and systemic inflammatory response, leading to multiple organ dysfunction or infections. Damage Control focuses on preventing additional surgical harm, emphasizing timely stabilization and nutritional support for recovery.