A Hoffa fracture is a type of supracondylar distal femoral fracture with fracture line located in the coronal plane. It is a rare injury consisting of tangential (coronal shear) fracture of distal femoral condyles. Unicondylar knee fractures are rare and present some diagnostic difficulties due to poor visibility on standard X-ray and are especially harder to identify in non-displaced fracture. A fifty-four-year-old male presented to our emergency room with a chief complaint of pain over his right knee that started 10 months prior. He previously was involved in a motor vehicle accident and underwent open reduction and internal fixation with plate and screws. Physical examination revealed swelling and tenderness over the right knee with limited range of motion. Plain X-ray showed union of tibia plateau fracture with plate and screws and no evidence of distal femoral fracture. A magnetic resonance imaging of the right knee was performed and revealed an intraarticular lateral condyle femur fracture with transverse configuration that was previously missed on plain X-ray. Arthroscopy-assisted reduction and internal fixation using antero-posterior and postero-anterior oriented screws were performed and good reduction was achieved. Diagnosis of this type of fracture is challenging and require some experience. Awareness of such entity and strong clinical suspicion are essential for diagnosis because most of the time the standard X-rays may appear normal. Arthroscopy-assisted fracture fixation using antero-posterior and postero-anterior oriented screws for Hoffa fracture offers many advantages and allows for early mobilization postoperatively without any loss of reduction.

Background: Infection in open fractures is still a problem that cannot be fully managed. Various types of studies have been conducted to find an effective and efficient solution to wash open fracture wounds. This study compared the effectiveness of ascorbic acid irrigation in reduction of Staphylococcus aureus colony and interleukin-6 (IL-6) serum level as systemic inflammation marker in debridement procedure of grade II Gustilo-Anderson open fracture of long bones.Methods: This study was an experimental study with pre-post-test control group design. This study included 24 subjects aged 15-75 years old with Gustillo-Anderson type II open fractures which were divided into two groups. The treatment group had additional irrigation by using 10 mg/ml ascorbic acid solution during debridement, whereas the control group had debridement only without irrigation with ascorbic acid. The culture and colony count of Staphylococcus aureus and IL-6 serum level was obtained and measured before and after the treatment in both groups. Statistical analysis (Wilcoxon test) was performed to compare the difference of the two parameters (Δ colony count and Δ IL-6) before and after the treatment.Results: There were no significant difference in Δ colony count of Staphylococcus aureus (p=0.308) and ΔIL-6 serum level (p=0.239) between the control group and treatment group.Conclusions: Ascorbic acid irrigation was not proved to decrease the colony count of Staphylococcus aureus and IL-6 serum level in grade II open fracture of long bones.

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Trimalleolar fractures are one of the most complex fracture around ankle. This study aims to assess the functional outcome and result of the surgical treatment for trimalleolar fracture. Case 1: A 49-years-old male experience closed fracture left ankle Lauge-Hansen PER type IV caused by traffic accident. Patient present with swollen and painful around ankle with an inability to bear weight on the affected extremity. Case 2: A 36-years-old female sustained closed fracture at right trimalleolar ankle, closed fracture at right talus nondisplace Hawkins I, and closed fracture at second, third, and fourth metatarsal. Case 3: A 57-years-old female came with history the left ankle twisted after got slipped and fell down at the yard. Patient was diagnosed by closed fracture left ankle Lauge Hansen SER type IV. Ankle fracture mostly happen in young men and older women during sporting activities or even bicycle or car accidents. The Lauge-Hansen system classify the fracture based on the postion and the direction of the ankle when trauma happen. The AOFAS was use for evaluation patient-relevant outcomes in patients operated on with anatomical ankle injury. In or present study of 3 patients with ankle fractures that were unstable, displaced or both treated surgically by open reduction with internal fixation in accordance with Lauge-Hansen classification. The result in our series confirm that all of 3 patients have a good result based on AOFAS scoring for evaluation the treatment and it means the management approve the good functional outcomes for the patients with ankle fractures.