Orthopaedic Management For A Delayed Presentation Of A Traumatic ‘Floating Knee’ Injury In Rural Uganda Due To Inequality: A Case Report

GASOC International Conference 2025
ABSTRACT FIRST PRESENTED: 24.10.2025

doi: 10.52648/GASOC.1006_297

Orthopaedic Management For A Delayed Presentation Of A Traumatic ‘Floating Knee’ Injury In Rural Uganda Due To Inequality: A Case Report

Daniel Murray, Bart Tijsebaert
University Hospitals Plymouth NHS Trust, Exeter, United Kingdom; Ghent University Hospital, Ghent, Belgium

Background: Bwindi Community Hospital (BCH) is a small but rapidly growing facility in southwest Uganda, serving a large geographical area with high rates of poverty. Patients contribute financially for their care but despite an insurance scheme, many people still struggle.

Case: A 21 year old male was hit by a motorcycle on a dirt road and suffered a right leg injury. He was unable to afford treatment, and elected for conservative lower limb immobilisation. After 8 months of non weightbearing, he returned to BCH with profound leg deformities. X-rays confirmed ipsilateral diaphyseal fractures of the femur, tibia and fibula, resulting in a ‘Floating Knee’, with significant malunion and callus formation. The patient was still unable to afford treatment, and ultimately the surgery was funded by private donors.

Two operations were performed for femoral and then tibial fixation. Both involved extensive callus resection, realignment and nail insertion with proximal & distal screw fixation. The operations were successful and the patient discharged with the expectation of regaining full limb function.

Discussion: There is a high burden of trauma in Uganda due to poor roads, and access to treatment is limited by both geographical and financial factors. Here, this resulted in an 8 month delay in treatment, significantly impacting the patient’s quality of life and complicating management.
Even the most affordable systems, such as with BCH, can prove inhibitory for populations living in poverty. However, safe and life changing orthopaedic surgery is now available in rural Uganda, if only these barriers can be overcome.

Keywords: Trauma, Orthopaedic, Delayed Presentation, Uganda, Inequality

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