Background: The floating knee is an ipsilateral fracture of the femur and tibia. It occurs in the context of high-energy trauma, mainly caused by road accidents.

Objective: The aim of this study was to analyse the management of fractures at Centre Hospitalier Universitaire la Référence Nationale.

Materials and method: This was a retrospective, descriptive study from 1 January 2016 to 31 December 2021 on the records of patients treated and monitored for floating knees in the Orthopaedics and Traumatology Department of the Centre Hospitalier Universitaire la Référence Nationale. Fractures were classified according to the Fraser classification, and the opening was according to the Gustilo-Enderson classification. Functional and anatomical results were assessed according to the Karlstrom and Olerud criteria.

Results: This is a retrospective series of 23 floating knees out of 1578 pelvic limb fractures, i.e. a frequency of 1.45%, including 20 in men (87%) with a sex ratio of 6.6. The mean age was 33.2 years. The aetiologies were dominated by AVP (95.7%) involving the motor-vehicle pair (52.2%). The lesion was more localized on the left (60.9%). There were 73.9% skin openings, mainly on the leg (58.8). Gustilo-Enderson type II predominated in the femur and tibia. FRASER type I fractures were the most common at 43.5%, followed by type II (21.7%). Surgical treatment (73.9%) used plates screwed to the femur (63.2%) and tibia (58.8%). Complications were dominated by stiffness (50%). With an average follow-up of 68 months, the anatomical and functional results were deemed satisfactory (excellent 30.4% and good 34.8%).

Conclusion: The floating knee is a complex, uncommon, but severe injury. It mainly affects young men, requiring urgent medical and surgical intervention. Diagnosis is based on clinical examination and radiological confirmation. Treatment must be surgical and early to maximize recovery and minimize complications. Prevention of road accidents remains essential.