Fractures of the ipsilateral femur and tibia: emphasis on intra-articular and soft tissue injury.

Twenty-one patients with fractures of the ipsilateral femur and tibia were treated at Boston City Hospital from 1982 through 1987. Fourteen (67%) of the 21 patients sustained a total of 17 open fractures (76% of which were grade II or III wounds). Over 50% of the patients suffered concomitant ipsilateral knee injuries. Associated injuries required 37 nonorthopaedic procedures; 30 orthopaedic procedures were required to stabilize the axial skeleton and the other three extremities. Five patients ultimately required amputation, reflecting the magnitude of the initial high-energy trauma. Superior results were achieved when early rigid intramedullary fixation of the femur and rigid stabilization of the tibia with either an intramedullary nail or an external fixator was undertaken. Patients that underwent initial rigid intramedullary fixation of both the femur and tibia required fewer secondary operative procedures than those treated with primary external fixation. Rigid internal fixation allowed for thorough evaluation and treatment of the ligamentous structures of the knee and facilitated management of the soft tissue trauma.