Introduction: Coronal plane FRACTUREs of the femoral condyle are known as Hoffa FRACTUREs. Although isolated posterior HoffaFRACTUREs of medial femoral condyle have been rarely reported, no reports are available regarding the anterior FRACTURE of this type. Here, we report a large isolated anterior osteoarticular FRACTURE of the medial femoral condyle. Case Presentation: A 16-year-old girl with a traumatic open joint injury of the right knee caused by a car-to-pedestrian accidentwas referred to our emergency department for further evaluation. A physical examination of the knee revealed effusion and limitedknee range of motion. While no obvious FRACTURE was detectable on plain radiographs of the knee, a large anterior osteoarticularFRACTURE of the medial femoral condyle was observed in computed tomography (CT), which was detached from the medial condyle. The FRACTURE was managed with open reduction and internal fixation. Eight weeks after the surgery, the patient retrieved the fullknee motions and the complete union of the FRACTURE was observed. No complication was reported by the patient at a follow-upperiod of 12 months. Conclusions: In cases with knee tenderness and/or effusion and normal plain radiographs, whenever there is a discrepancy betweenplain radiographsandclinicalsymptomsof the patient, a further evaluation of the knee with a CT scan and/orMRIis necessaryto avoid missing a Hoffa FRACTURE, which could be successfully treated if timely diagnosed.

Introduction: Lunate FRACTURE is a rare injury. Most reports are associated with other wrist injuries such as perilunate dislocation and distal radius FRACTURE. Isolated lunate FRACTURE has been reported even more rarely. The choice of treatment and outcomes are consequently undetermined.Case Presentation: In this case report we will describe a lunate avulsion FRACTURE as an isolated injury after a fall from nine meters treated operatively by excision of the comminuted avulsed fragment. After 33 months of follow-up radiographs showed no sign of degenerative joint disorder on simple X-ray, but slight Volar Intercalated Segment Instability (VISI) by a capitolunate angle of 26 degrees was noted. Clinically, the patient was pain free near full wrist and forearm range of motion and could perform his previous vocational and recreational tasks without any limitations.Conclusions: Despite apparently good short and mid-term clinical outcome, slight volar intercalated segment instability after 33 months of follow-up revealed that lunotriquetral ligament function was probably lost, which led to static instability. This ligament injury may be missed primarily. Excision of the avulsed OSTEOCHONDRAL fragment should be the last option of treatment and most attempts should be tried to fix and/or restore the normal anatomy of ligamentous structure.

Subtalar dislocation is the simultaneous dislocation of the distal articulations of the talus at both the talocalcaneal and talonavicular joints. It can occur in any direction and always produce significant deformity. Most common is the medial dislocation (80% of cases). Less common presentations are lateral (20% of cases), anterior and posterior dislocations. These dislocations are associated with OSTEOCHONDRAL FRACTUREs. Closed reduction and immobilisation remains the mainstay of treatment. Proper radiographs and CT scan confirms the post reduction alignment stability of subtalar joints and intraarticular FRACTURE fragments. We report a case of medial subtalar dislocation with no OSTEOCHONDRAL FRACTURE fragments in a 17-year-old young man.

Statement of Problem: In a previous study it was reported that a durable resin-ceramic tensile bond could be obtained by an appropriate silane application without the need for HF acid etching the ceramic surface. Evaluation of the appropriate application of silane by other test methods seems to be necessary.Purpose: The purpose of this study was to compare the interfacial FRACTURE toughness of smooth and roughened ceramic surfaces bonded with a luting resin.Materials and Methods: Ceramic discs of 10 mm in diameter and 2 mm in thickness were prepared.Four different surface preparations (n=10) were carried out consisting of (1) ceramic surface polished to a 1µm finish, (2) gritblasted with 50µm alumina, (3) etched with 10% HF for 2 min, and (4) gritblasted and etched. The ceramic discs were then embedded in PMMA resin. For the adhesive area, the discs were masked with Teflon tapes. A circular hole with diameter of 3 mm and chevron-shaped with a 90° angle was punched into a piece of Teflon tape. The exposed ceramic surfaces were treated by an optimised silane treatment followed by an unfilled resin and then a luting resin cylinder of 4mm in diameter and 11 mm in length was built. Specimens were stored in two different storage conditions: (A): Distilled water at 37°C for 24 hours and (B): Distilled water at 37°C for 30 days. The interfacial FRACTURE toughness (GIC) was measured at a cross-head speed of 1 mm/min. The mode of failure was examined under a stereo-zoom microscope and FRACTURE surfaces were examined under Scanning Electron Microscope.Results: The mean interfacial FRACTURE toughness values were; Group A: 1) 317.1±114.8, 2) 304.5±109.2, 3) 364.5±169.8, and 4) 379.4±127.8 J/m2±SD. Group B: 1) 255.6±134.4, 2) 648.0±185.1, 3) 629.3±182.6 and 4) 639.9 ±489.0 J/m2±SD. One way Analysis of Variance showed that there was no statistically significant difference in the mean interfacial FRACTURE toughness for groups A1-A4 (P>0.05). However, the mean interfacial FRACTURE toughness for group B1 was significantly different from that for groups B2, B3 and B4 (P<0.05). Independent-ٍٍٍSamples T-Test results showed that there was a significant increase in the GIC mean value for groups B2 and B3 after 30 days water storage (P<0.05). The modes of failure were predominantly interfacial or cohesive within the resin.Conclusions: The FRACTURE toughness test method used in this study would be appropriate for analysis of the adhesive zone of resin-ceramic systems. From the results, it can be concluded that micro-mechanical retention by gritblasting the ceramic surfaces could be sufficient with no need for HF acid etching the ceramic surfaces when an appropriate silane application procedure is used.

Background: Different methods have been used for reconstruction of post-traumatic OSTEOCHONDRAL defects of knee. We report the long term results of fresh OSTEOCHONDRAL allograft for such defects. Materials and Methods: Fresh OSTEOCHONDRAL allografts were used for post traumatic knee defects larger than 3cm in diameter and 1 cm in depth. Harvesting of the graft was carried out within 24 hours of the donors' death. Implantation into the recipient was carried out within 72 hours. The grafts were unipolar, fixed by screws and combined with realignment osteotomy if a deformity was present. Meniscal transplantation was also performed when indicated. Results: The survivorship of all grafts in plateaus and condyles at 7.5 years was 85%. This surviorship for femoral condyle was 85% at 10 years. Viable hyaline cartilage was confirmed at 17 years Post surgery. Conclusion: Possibility of reconstrution of big defects (more than 3 cm) and absence of donor site morbidity as in autografts, favour the use of fresh allografts for knee osteoarticular defects.

The main indications for OSTEOCHONDRAL allografts (OCA) transplantation of the knee are the following: Symptomatic full-thickness cartilage lesions greater than 3 cm 2; deep lesions with subchondral damage; and revision techniques when a previous surgical procedure has failed. Dowel and shell techniques are the two most commonly used for OCA transplantation. The dowel technique is appropriate in most cartilage lesions; however, geometrically irregular lesions may need the shell technique. Factors related to better outcomes after OCA transplantation are the follow ing: unipolar lesions; patients younger than 30 years; traumatic lesions; and when the treatment is carried out within 12 months from the onset of symptoms. A systematic review found a survivorship rate of 89% at 5 years. Other systematic review showed a mean failure rate of 25% at 12 years with a reoperation rate of 36%. Seventy-two per cent of the failures were conversion to total knee arthroplasty (TKA) (68%) or unicompartmental knee arthroplasty (UKA) (4%). Twenty-eight per cent of failures were graft removal, graft fixation, and graft revision. In this systematic review, patellofemoral lesions (83%) had a higher reoperation rate than lesions affecting the tibial plateau or the femoral condyles. Overall, OCA transplantation showed a successful result in 75% of patients at 12 years follow-up.

Background: Autogenous OSTEOCHONDRAL grafting of articular defect in weight-bearing surface of large joints has proven to be a proper biomechanical and physiological solution for localized full-thickness defects. Objective: To study the gross and histopathological results of mosaicplasty in an animal model (sheep's medial femoral condyle), evaluating the factors of defect and graft size, assessing the effect of fixation with only cancellous bone impaction between graft columns, and early free post-operative motion. Methods: Fourteen medium sized sheep were the subject of the study. Cylindrical OSTEOCHONDRAL grafts of 4 mm and 6 mm diameter and 1 cm length from the periphery of the medial femoral condyles at the patellofemoral joint were used to fill corresponding 8 mm and 15 mm diameter cylindrical defects of 1 cm depth at the weight-bearing surface of medial femoral condyles. The spaces between the grafts were packed with cancellous bone with double gloved thumb. The sheep were free for activities and weight bearing after the operation. Two of the 14 sheep died. The first due to sepsis and the other of cardiorespiratory arrest during anesthesia induction. All sheep were sacrificed after 4 months and their knees collected as specimens for further gross and histopathological studies.Results: All grafted defects except one healed with smooth cartilage. The quality of cartilage was evaluated by histopathological criteria, rating the cellular morphology, surface regularity as well as structural integrity and thickness of cartilage, binding to adjacent normal cartilage and clustering. Twenty-three out of 24 specimen showed excellent or good result, that is a success rate of 95.8%.Conclusion: Mosaicplasty, autogenous OSTEOCHONDRAL grafting in this animal study was effective and successful even in larger defects of 15 mm diameter. Cancellous bone cementing between the cylindrical grafts, respecting the normal convexity of the femoral condyle insertion of obliquely harvested grafts at the periphery of the defects and freedom of motion and activity were all helpful in obtaining good results 4 months after graft implantation.