Bilateral Open Floating Knee in a Young Functional Patient: Case Report.

Abstract

Background: Bilateral floating knee injuries represent rare, high-energy trauma patterns associated with severe soft-tissue damage, high complication rates, and challenging functional recovery. Case presentation: We report the case of a young male nurse who sustained bilateral complex lower-limb injuries after a high-speed motor vehicle collision, including bilateral distal femoral fractures, tibial plateau fractures, Lisfranc injuries, and multiple metatarsal fractures, consistent with bilateral Fraser type IIC floating knee injuries. Management followed a staged damage-control strategy with initial external fixation, followed by definitive internal fixation. The clinical course was complicated by postoperative infection with Klebsiella pneumoniae, requiring surgical debridement and antimicrobial therapy. Subsequent reconstructive procedures were performed in a staged manner. Long-term follow-up demonstrated progressive functional recovery. Results: After implant removal and rehabilitation, the patient achieved 110° of knee flexion and full extension, muscle strength 5/5 in all muscle groups (Daniels scale), and a “good” functional outcome according to the Karlström and Olerud score. He returned to full work activities as a nurse and resumed physical exercise, including functional training, with only intermittent pain controlled by conventional analgesics. Conclusion: A staged surgical strategy combined with structured rehabilitation can lead to satisfactory functional outcomes in complex bilateral floating knee injuries, even in the presence of infectious complications. Multidisciplinary management and long-term follow-up are essential for optimizing recovery.