Introduction: Floating bone injury or
bipolar dislocation is a concurrent dislocation at both ends of a long bone or
a flat bone. It is an exceptional injury. We report 11 consecutives cases of floating
bones. Objectives: The aim of the study is to analyze the frequency, the
mechanism of injury and clinical forms of floating bones, and to present the
results of their management. Material and Methods: A ten years ongoing
retrospective study was held in four trauma departments. Eleven cases of
floating bones were identified. The floating bones characteristics such as the
injured bone, the patient age and sex, the mechanism of injury, the dislocations
directions, the associated complications, the treatment and the outcome were
studied. Results: Nine male and two female patients, with a mean age of
37 years [19 - 65 years range] presented a concurrent bipolar
dislocation of one bone or a group of bones. They sustained a road traffic accident (n = 5), a
workplace accident (n = 3), a fall from height (n = 2), and a sport accident (n
= 1). The clavicle (n = 3) and the first metatarsal (n = 3) were the most
frequently involved. The others floating bones were the radius-ulna complex (n
= 1), the radius-lunatum complex (n = 1), the first metacarpal (n = 1), the
first phalanx (n = 1) and the femur (n = 1). The floating bones ends
displacement occurred in the sagittal plane (the forearm, the femur, the first
phalanx and the first metatarsal) and in the horizontal plane (the clavicle,
the first metatarsal and the first metacarpal). We defined direction
displacements as bidirectional asymmetric (n = 10) or unidirectional symmetric
(n = 1). Associated complications were fractures (wrist, hip, tarso-metatarsal
joints) and wounds (fingers, metatarso-phalangeal joint). Dislocations were
treated conservatively (n = 5) and surgically (n = 17) with excellent results
(n = 13/16 joints). Three patients were lost
of view. Conclusion: Our study described the characteristics of
this exceptional injury. For any joint dislocation, we promote the systematic
examination of the other end of the dislocated bone.
References
[1]
Benabdallah, O. (1991) Bipolar Dislocation of Clavicle. Case Report. Revue de Chirurgie Orthopedique et Reparatrice De L’Appareil Moteur, 77, 263-266.
[2]
Eni-Olotu, D.O. and Hobbs, N.J. (1997) Floating Clavicle—Simultaneous Dislocation of Both Ends of the Clavicle. Injury, 28, 319-320. https://doi.org/10.1016/S0020-1383(97)00009-0
[3]
Dieme, C., Bousso, A., Sane, A., Sane, J.C., Niane, M., Ndiaye, A., Sy, M.H. and Seye, S. (2007) Bipolar Dislocation of the Clavicle or Floating Clavicle. A Report of 3 Cases. Chirurgie de la Main, 26, 113-116. https://doi.org/10.1016/j.main.2007.02.004
[4]
Gearen, P.F. and Petty, W. (1982) Panclavicular Dislocation. Report of a Case. The Journal of Bone and Joint Surgery American Case Connector, 3, 454-455. https://doi.org/10.2106/00004623-198264030-00019
[5]
Jain, A.S. (1984) Traumatic Floating Clavicle. A Case Report. The Journal of Bone and Joint Surgery (British Volume), 66, 560-561.
[6]
Leibner, E.D., Mattan, Y., Shaoul, J. and Nyska, M. (1997) Floating Metatarsal: Concomitant Lisfranc Fracture-Dislocation and Complex Dislocation of the First Metatarsophalangeal Joint. Journal of Trauma and Acute Care Surgery, 42, 549-552. https://doi.org/10.1097/00005373-199703000-00028
[7]
Milankov, M., Miljkovic, N. and Popovic, N. (2003) Concomitant Plantar Tarsometatarsal (Lisfranc) and Metatarsophalangeal Joint Dislocations. Archives of Orthopaedic and Trauma Surgery, 123, 95-97. https://doi.org/10.1007/s00402-003-0477-0
[8]
Trinquier, J.L., Filloux, J.F., Paul, H., Jarde, O. and Vives, P. (1995) Bipolar Dislocation of the First Metatarsal Bone. Acta Orthopaedica Belgica, 61, 238-241.
[9]
Porral, A. (1831) Case Report of a Double Dislocation of the Right Clavicule Bone. Medical and Practical Surgery Journal, 2, 78-82.
[10]
Jain, R. and Jain, S. (2006) The Floating First Metatarsal: A Case Report. The Journal of Foot & Ankle Surgery, 45, 34-37. https://doi.org/10.1053/j.jfas.2005.10.001
[11]
Espiérrez, J.C., Martínez, á.A., Herrera, A. and Panisello, J.J. (2003) The Floating Metatarsal: First Metatarsophalangeal Joint Dislocation with Associated Lisfranc Dislocation. Journal of Foot & Ankle Surgery, 42, 309-311. https://doi.org/10.1016/S1067-2516(03)00308-9
[12]
Dieme, C., Sane, A., Ngom, G., Sane, J., Ndiaye, A. And Seye, S. (2004) The Floating First Metatarsal: A Case Report. Médecine et Chirurgie du Pied, 20, 110-111. https://doi.org/10.1007/s10243-004-0025-9
[13]
Dakouré, P.W.H., Soulama, M., Gandéma, S., Diallo, M. and Da, S.C. (2011) Floating First Metatarsal: A Case Report. Médecine et Chirurgie du Pied, 29, 94-97. https://doi.org/10.1007/s10243-013-0375-2
[14]
Zejjari, H., Louaste, J., Chkoura, M. and Rachid, K. (2011) Floating Forearm: Case Report. Chirurgie de la Main, 30, 155-158. https://doi.org/10.1016/j.main.2011.02.002
[15]
Najeb, Y., Essadki, B., Latifi, M. and Fikry, T. (2007) Bipolar Dislocation of Forearm: Elbow Dislocation and Transcapholunate Wrist Dislocation. Case Report. Chirurgie de la Main, 26, 62-64. https://doi.org/10.1016/j.main.2006.09.003
[16]
Motsis, E., Pakos, E., Zaharis, K., Korompilias, A. and Xenakis, T. (2006) Concomitant Ipsilateral Traumatic Dislocation of the Hip and Knee Following High-Energy Trauma: A Case Report. Journal of Orthopaedic Surgery (Hong Kong), 14, 322-324. https://doi.org/10.1177/230949900601400317
[17]
Vaseenon, T., Wongtriratanachai, P. and Laohapoonrungsee, A. (2010) Ipsilateral Anterior Hip Dislocation and Posterior Knee Subluxation: A Case Report. Journal of the Medical Association of Thailand, 93, 128-131.
[18]
Suman, R.K. (1981) Simultaneous Dislocations of the Shoulder and the Elbow. Injury, 12, 438-438.
[19]
Moore, J.R., Webb, C.A. and Thompson, R.C. (1978) A Complete Dislocation of the Thumb Metacarpal. Journal of Hand Surgery (American Volume), 3, 547-549. https://doi.org/10.1016/S0363-5023(78)80004-5
[20]
Khodadadyan, C., Hoffmann, R., Moazami-Goudarzi, Y. and Sudkamp, N.P. (1995) Double Dislocation of the Fifth Metacarpal. Journal of Hand Surgery (British Volume), 20, 253-254. https://doi.org/10.1016/S0266-7681(05)80064-6
[21]
Ibrahim, S. and Noor, M.A. (1993) Simultaneous Dislocations of the Carpometacarpal and Metacarpophalangeal Joints of the Thumb. Injury, 24, 343-344. https://doi.org/10.1016/0020-1383(93)90062-B
[22]
Gerard, F., Tropet, Y. and Obert, L. (1999) Trapezo-Metacarpal and Metacarpo- Phalangeal Dislocation of the Thumb Associated with a Carpo-Metacarpal Dislocation of the Four Fingers. Annales de Chirurgie de la Main et du Membre Supérieur, 18, 205-208. https://doi.org/10.1016/S1153-2424(99)80007-7
[23]
Kulshreshtha, R., Venu, K., Qureshi, F. and Lahoti, O. (2005) Divergent Dislocation of Elbow with Ipsilateral Distal Radioulnar Joint Dislocation in a Gymnast. European Journal of Trauma, 31, 495-498. https://doi.org/10.1007/s00068-005-1039-7
[24]
Hey, H.W., Huh Lau, B.P., Thambiah, J., Khong, K.S. and Murphy, D.P. (2013) “Floating Fibula” Secondary to Traumatic Dislocation of the Ankle Joint, Ankle Syndesmosis, and the Proximal Tibiofibular Joint. A Case Report. The Journal of Bone and Joint Surgery American Case Connector, 3, 101-105.
[25]
Unay, K., Ozkan, K., Ugutmen, E., Ozkan, F.U., Eren, A. and Bilsel, K. (2008) Simultaneous Ipsilateral Proximal Interphalangeal and Metacarpophalangeal Dislocation of the Fifth Phalanx: A Case Report. Cases Journal, 3, 208. https://doi.org/10.1186/1757-1626-1-208
[26]
Bartels, M. (1874) Traumatic Dislocation. Archives de Chirurgie in French, Surgery archives, 16, 645.
[27]
Dodd, C.A. (1987) Triple Dislocation in the Upper Limb. Journal of Trauma-Injury Infection & Critical Care, 27, 1307. https://doi.org/10.1097/00005373-198711000-00019
[28]
Sivan, M., Davies, N., Archibald, C. and Pailthorpe, C. (2005) An Unusual Combination of Radiocarpal Fracture Dislocation, Scaphoid Fracture and Posteromedial Elbow Dislocation. Injury Extra, 36, 312-315. https://doi.org/10.1016/j.injury.2004.12.057
[29]
Chen, W.S. (1994) Concurrent Perilunate Dislocation in Patients with Elbow Dislocation: Case Reports. Journal of Trauma-Injury Infection & Critical Care, 37, 504-507. https://doi.org/10.1097/00005373-199409000-00029
[30]
Ovadia, D., Steinberg, E.L., Mozes, G. and Menahem, A. (2001) “Floating Tibia-Talus Complex”—An Ipsilateral Dislocation of the Knee and the Subtalar Joint in an Elderly Patient: A Case Report and Review of the Literature. Journal of Foot and Ankle Surgery, 40, 113-115. https://doi.org/10.1016/S1067-2516(01)80054-5
[31]
Moonen, A., Tilman, P., van der Ent, F. and Verburg, A. (2006) Obturator Dislocation of the Hip with Associated Open Book Fracture of the Pelvis. Injury Extra, 37, 319-321. https://doi.org/10.1016/j.injury.2006.02.017
[32]
Essoh, J.B.S., Kodo, M., Traoré, A. and Lambin, Y. (2005) Ipsilateral Dislocation of the Shoulder and Elbow: A Case Report. Nigerian Journal of Surgical Research, 7, 319-320.
[33]
Arenas, A., Pampliega, T. and Iglesias, J. (1993) Surgical Management of Bipolar Clavicular Dislocation. Acta Orthopædica Belgica, 59, 202-202.
[34]
Kamboj, P., Kundu, Z., Sangwan, S. and Walecha, P. (2007) Ipsilateral Anterior Hip and Posterior Knee Dislocation with Common Peroneal Nerve Palsy: A Particular mode of Trauma in a Case. The Internet Journal of Orthopedic Surgery, 6.
[35]
English, T.A. (1964) Dislocations of the Metatarsal Bone and Adjacent Toe. The Journal of Bone and Joint Surgery. British Volume, 46, 700-704.
[36]
Sommer, C., Leutenegger, A. and Rüedi, T. (1998) The Floating Joint Injury of the Lower and Upper Extremity: Epidemiology, Therapy and Results in 40 Extremities. Swiss Surgery, 4, 163-169.
