Flake Fractures Research Articles

Hoffa fractures are associated with concomitant soft tissue injures and a high postoperative complication rate

IntroductionHoffa fractures are a rare and often overlooked entity. The main goal of surgical treatment is to restore the articular surface and maintain knee function. However, current clinical data indicate heterogeneous outcomes. The aim of this multicenter study was to obtain a representative data set of patients with isolated Hoffa fractures with special emphasis on concomitant soft tissue injuries, diagnostic algorithms, treatment strategies and functional outcomes.Materials and methodsParticipating Level I trauma centres were asked to review their internal database for isolated Hoffa fractures treated surgically between 2010 and 2020. Demographics, mechanism of injury, diagnostic and therapeutic algorithm, Letenneur classification, concomitant soft tissue injuries, and postoperative knee function and complications were analysed.ResultsA total of 56 patients from six participating trauma centres were included. The median age at injury was 45 years (15–94) with a median follow-up of 19 months (2–108). The most common mechanism of injury was high-energy trauma, with unicondylar lateral Letenneur type I and II fractures being the most common. Surgical treatment was independent of the type of fracture and included isolated screw fixation, combined plate and screw fixation and isolated plate osteosynthesis. Isolated screw fixation resulted in significantly better range of motion (ROM) values (p = 0.032), but the highest number of postoperative complications (n = 14/20, n.s.) compared to the other fixation techniques. The highest number of fixation failures requiring revision was observed in the plate and screw fixation group (n = 3/8, p = 0.008). Osteochondral flake fractures (n = 12/43, 27%) and lateral meniscus injuries (n = 5/49, 10%) were commonly seen in Hoffa fractures.ConclusionsTreatment of Hoffa fractures with screw fixation resulted in significantly better functional outcomes, probably due to less comminuted fractures. Concomitant cartilage, meniscal and ligamentous injuries are common and warrant preoperative recognition and management.

Osteoarticular Open Flake Fracture Refixation: The “Parachute” Technique

Osteochondral fractures of the patella, also known as “flake fractures,” frequently occur after patellar dislocation. In such fractures, a piece of patellar cartilage with subchondral bone breaks off due to patellar dislocation or subsequent reposition. Various surgical techniques have evolved for surgical therapy with the goal of realigning the patellar cartilage. This article presents a cost-effective surgical technique for achieving stable refixation of large osteochondral fragments in patellar flake fractures. The proposed technique entails creating transosseous tunnels in a confluent fashion at the margins, exactly between the fragment and the natural cartilage. Sutures are passed through the established tunnels for flake refixation. This refixation method ensures evenly distributed pressure without penetration of the fragment itself, resulting in the formation of a characteristic parachute configuration composed of confluent bone tunnels and absorbable sutures. The suitability of flake refixation is assessed through an algorithm, allowing for appropriate patient selection. The described technique offers several advantages, including its simplicity and cost-effectiveness, a flexible configuration of the sutures, and the ability to provide stable refixation for large osteochondral fragments.

Loose Bodies Found in the Human Intra-Articular Space Showed Characteristics Similar to Endochondral Bone Formation.

Loose bodies are free-floating tissues of cartilage and bone that can cause pain, swelling, the inability to straighten the knee, or intermittent locking of the knee. Loose bodies can arise from degenerative joint disease, flake fractures, osteochondritis dissecans, or chondromatosis. We hypothesized that loose bodies can be classified in stages with tissue characteristics similar to endochondral ossification. Loose bodies were harvested from patients undergoing joint replacement. Samples were processed for histology, gene expression analysis, and micro-computed tomography (µCT). Cartilage- and bone-related genes and proteins were selected for immunofluorescence stainings (collagen type I, II, and X, SOX9 [SRY-box transcription factor 9], and MMP13 [matrix metalloproteinase 13]) and gene expression analysis (FN [fibronectin], COL1A1, COL2A1, COL10A1, SOX9, MMP13, and aggrecan [ACAN]). Loose bodies were grouped in 4 stages: fibrous, (mineralized) cartilaginous, cartilage and bone, and bone. Hyaline-like cartilage tissue with Benninghoff arcades was present in stages 2 and 3. A transition from cartilaginous to mineralized tissue and bone trabecula was defined by an increase in COL1A1 and COL10A1 (stage 3 vs. 4: p = 0.047) positive area. Stage 4 showed typical trabecular bone tissue. The relative volume of calcified tissue (mineralized cartilage and bone tissue) decreased with stages (stages 1-2 vs. 3: p = 0.002; stage 1-2 vs. 4: p = 0.012). COL2A1 expression and stained area decreased from stages 1-2 to 4 (p = 0.010 and p = 0.004). ACAN expression decreased from stage 1-2 to stage 3 (p = 0.049) and stage 4 (p = 0.002). Loose bodies show tissue characteristics similar to endochondral ossification. They are probably a relevant substrate for regenerative therapeutic interventions in joint disease.

Excellent Clinical and Radiological Outcomes after both Open Flake Refixation and Autologous Chondrocyte Implantation following Acute Patella Dislocation and Concomitant Flake Fractures

Excellent Clinical and Radiological Outcomes after both Open Flake Refixation and Autologous Chondrocyte Implantation following Acute Patella Dislocation and Concomitant Flake Fractures

Excellent clinical and radiological outcomes after both open flake refixation and autologous chondrocyte implantation following acute patella dislocation and concomitant flake fractures

PurposeTo investigate clinical and magnetic resonance (MR) imaging results of patients undergoing patella stabilization with either open flake refixation (oFR) or autologous chondrocyte implantation (ACI) and concomitant soft tissue patella stabilization after sustaining primary, acute patella dislocation with confirmed chondral and/or osteochondral flake fractures. It was hypothesized that refixation will lead to better results than ACI at mid-term follow-up.MethodsA retrospective chart review was conducted to identify all patients undergoing oFR or ACI after sustaining (osteo-)chondral flake fractures and concomitant soft tissue patella stabilization following primary, acute patella dislocation between 01/2012 and 09/2018 at the author’s institution. Patients were excluded if they were aged < 14 years or > 30 and had previous knee surgeries at the index knee. Clinical outcomes were assessed using the Tegner activity score, Kujala score, subjective IKDC score, and the KOOS score at a minimum follow-up of 24 months postoperatively. MR images were assessed using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 knee score. Thirty patients were included in the study, with 16 patients assorted to the oFR group and 14 patients to the ACI group (Follow-up 81%).ResultsDemographic data did not show significant group differences (oFR: 6 females, 10 males; age 26.9 ± 5.6 years, FU: 57 months (27–97 months); ACI: 9 females, 5 males; age 25.5 ± 4.9 years, FU: 51 months (29–91 months); n.s.). Defect location was similar in both groups (oFR: 12 × patella/4 × lateral femoral condyle; ACI: 12/2; n.s.). Both groups showed excellent clinical outcomes, with no statistically significant difference between both the groups (oFR group vs. ACI group: Tegner: 5.1 ± 1.8 vs. 5.1 ± 1.4; Kujala: 86.1 ± 12.6 vs. 84.9 ± 9.1; IKDC: 83.8 ± 15.0 vs. 83.6 ± 11.3; KOOS: 83.3 ± 14.0 vs. 83.6 ± 12.0; n.s.). One patient in each group suffered a patella re-dislocation and needed revision surgery. The MOCART 2.0 score showed good results for the oFR group (68.2 ± 11.1) and the ACI group (61.1 ± 16.9) while no significant differences were noted between both the groups. The inter-rater reliability was excellent (0.847).ConclusionOpen refixation of (osteo-)chondral fragments in patients after sustaining acute patella dislocation with (osteo)-chondral flake fractures led to good clinical and radiological results at a minimum follow of 24 months, showing that it is a good surgical option in the treatment algorithm. However, if open refixation is not possible, ACI may be an excellent fallback option in these younger patients with equally good clinical and radiological outcomes, but requiring a second minimally invasive surgery.Level of evidenceIII.

Reconstruction of the medial patellofemoral ligament using autologous gracilis tendon in an implant-free technique on the patellar side

Anatomic reconstruction of the medial patellofemoral ligament using autologous gracilis tendon in an implant-free technique on the patellar side to regain patellofemoral stability. Recurrent dislocations, primary dislocation with high risk of recurrence, and dislocations with (osteo-)chondral flake fractures. As combined approach together with other procedures (trochleoplasty, tibial tubercle osteotomy). Revisions. As an isolated procedure in patients with high degrees of trochlear dysplasia, chronic dislocation of the patella, and patellofemoral maltracking without instability. Harvesting of the gracilis tendon. Drilling of a V-shaped tunnel with a special aiming device in anatomic position on the medial side of the patella. Drilling of a femoral tunnel in anatomic position under fluoroscopic control. Passage of the graft, arthroscopic-guided tensioning, and femoral fixation with a biodegradable interference screw. Partial weight bearing (20 kg) for 1-2 weeks. No limitation in range of motion. No orthosis. Specific sports allowed after approximately 3 months. Perioperative complications associated specifically with the technique were observed in 1.0% (7 of 729 cases). In a series of 72 consecutive cases from May 2010 to October 2010, the following were recorded after 4.0 ± 0.1 years: recurrent dislocations in 3.2%, a Tegner activity score of 5.1 ± 1.8, and subjective satisfaction in 92% (follow-up rate 87.5%). No fracture of the patella was seen in any of our patients.

The Ruled-out Scaphoid Fracture on Computed Tomography Prevalence and the Therapeutic Management of Other Carpal Fractures.

Dear editor, Suspicion of scaphoid fracture is a common topic in emergency medicine. If the radiograph is inconclusive, or there are typical symptoms suggestive of a scaphoid fracture despite a negative radiograph, further investigation with cross-sectional imaging is advocated. Because of its availability, computed tomography (CT) is the primary imaging method in most departments. In recent meta-analyses, CT has a pooled sensitivity of 93% and pooled specify of 99% to diagnose the scaphoid fracture (1). There are only sparse data about the prevalence of other carpal fractures in patients undergoing imaging the scaphoid with CT after trauma and the therapeutic consequences of these fractures. A retrospective analysis of 53 patients who underwent CT imaging of the wrist because of a clinically suspected scaphoid fracture was performed, despite a negative initial radiograph. The sample consisted of 36 men and 17 women with a mean age of 31.2 years presenting at our emergency department. All patients were examined between August 2009 and August 2011 using a 16- slice CT scanner (Activion ®, Toshiba Medical Systems, Tokyo, Japan) with a slice thickness of 0.5 mm. Data sets were post-processed on a standard medical workstation (Vitrea 2®, Vital Images, Minnetonka, USA). The scans were primarily reported by four different consultant radiologists. All data sets were reassessed by the author to ensure the correct primary diagnosis. The electronic medical charts of all patients were reviewed. On admission all patients were examined by a board certified hand surgeon, who decided about further treatment. If a fracture was found on imaging, a follow-up was routinely performed after 4-8 weeks and the patients were instructed to present at the emergency department if there were the new pain, pain worsening, limitations in motion or other uncertainties in the further follow-up. No fractures were identified in 23 patients (43.3%). A scaphoid fracture was found in 14 patients (26.4%). Fifteenth patients (28.2%) showed other fractures than the scaphoid (Figure 1). In nine out of 15 patients (60%), only the small flake fractures were found. In 6 patients, more than one carpal bone were affected. The triquetrum was the most affected carpal bone following the scaphoid. Only one patient showed a radio graphically occult fracture of the distal radius. Patients with scaphoid fractures were advised to undergo osteosynthesis to minimize the risk of pseudarthrosis. All patients showing fractures other than the scaphoid were treated conservatively with splinting and none of these patients received osteosynthesis at our hospital immediately or in the follow-up after trauma. Figure 1. Computed Tomography of a 27-Year-Old Patient After Trauma With Suspected Scaphoid Fracture and Negative Radiography The found prevalence of other carpal fractures than the scaphoid (in 28.2% of the patients) is higher than previously reported in the literature. Nguyen et al. reported a prevalence of 3.4% of other carpal fractures than the scaphoid in CT imaging because of the suspected scaphoid fracture (2). They did not further specify the type of CT scanner and the used slice- thickness, but because the data were recorded between 2001 and 2004, it may be speculated that a scanner with possibility of high-resolution multi planar reconstructions was not available. In a magnetic resonance imaging (MRI) study found in 14 patients (26.4%). by Brydie and Raby, the carpal fractures other than the scaphoid were found in 5% of the cases with a suspected scaphoid fracture and negative radiography (3). In another 10% of the cases, a bone bruise was only found. They also reviewed other MRI studies and found a cumulative prevalence of 6.5% for other carpal fractures than the scaphoid in studies examining patients with suspected scaphoid fracture. As they used a slice thickness of 3 mm, the small flake fractures were easily missed. In our small study, all the patients showing fractures other than the scaphoid were treated conservatively with splinting and none of these patients received osteosynthesis in our hospital immediately or in follow-up after the trauma. This may be explained by the type of fracture, being either flake fractures or only minimally displaced fractures negative on the conventional radiograph. In the study of Brydie and Raby, most patients with fractures other than the scaphoid and the patients with a bone bruise were only treated with immobilization and splinting. The main limitation of our small study is the retrospective design and therefore the non-structured follow-up, i.e. the long-term outcome could only be estimated. More data from other institutions, preferably in a prospective study with the structured follow-up, are needed before the findings of this study can be generalized. In conclusion, in a large portion of patients undergoing CT imaging for a suspected scaphoid fracture other carpal fractures can be found. But it seems that these incidentally found fractures can be treated conservatively in most patients.

Experimental Investigation on the Basic Law of the Fracture Spatial Morphology for Water Pressure Blasting in a Drillhole Under True Triaxial Stress

The present literature on the morphology of water pressure blasting fractures in drillholes is not sufficient and does not take triaxial confining stress into account. Because the spatial morphology of water pressure blasting fractures in drillholes is not clear, the operations lack an exact basis. Using a large true triaxial water pressure blasting experimental system and an acoustic emission 3-D positioning system, water pressure blasting experiments on cement mortar test blocks (300 mm × 300 mm × 300 mm) were conducted to study the associated basic law of the fracture spatial morphology. The experimental results show that water pressure blasting does not always generate bubble pulsation. After water pressure blasting under true triaxial stress, a crushed compressive zone and a blasting fracture zone are formed from the inside, with the blasting section of the naked drillhole as the center, to the outside. The shape of the outer edges of the two zones is ellipsoidal. The range of the blasting fracture is large in the radial direction of the drillhole, where the surrounding pressure is large, i.e., the range of the blasting fracture in the drillhole radial cross-section is approximately ellipsoidal. The rock near the drillhole wall is affected by a tensile stress wave caused by the test block boundary reflection, resulting in more flake fractures appearing in the fracturing crack surface in the drillhole axial direction and parallel to the boundary surface. The flake fracture is thin, presenting a small-range flake fracture. The spatial morphology of the water pressure blasting fracture in the drillhole along the axial direction is similar to a wide-mouth Chinese bottle: the crack extent is large near the drillhole orifice, gradually narrows inward along the drillhole axial direction, and then increases into an approximate ellipsoid in the internal naked blasting section. Based on the causes of the crack generation, the blasting cracks are divided into three zones: the blasting shock zone, the axial extension zone, and the orifice influence zone. The explosion shock zone is the range that is directly impacted by the explosive shock waves. The axial extension zone is the axial crack area with uniform width, which is formed when the blasting fracture in the edge of the explosion shock zone extends along the drillhole wall. The extension of the orifice influence zone is very large because the explosion stress waves reflect at the free face and generate tensile stress waves. In the water pressure blasting of the drillhole, the sealing section should be lengthened to allow the drillhole blasting cracks to extend sufficiently under the long-time effect of the blasting stress field of quasi-hydrostatic pressure.

Kindliche Kniebinnenverletzungen

Patella dislocations are the most common knee injuries causing hemarthrosis in children. Flake fractures represent the main complication of these injuries and require fixation. First time dislocations are treated conservatively. Recurrent dislocations are managed operatively. Precise analysis of the underlying dispositional and pathological factors is important to determine the appropriate operative procedure. To protect the growth plate, special techniques are required. Tibial spine fractures are bony avulsions of the anterior cruciate ligament (ACL). Management includes closed reduction in hyperextension and immobilization in a knee cast. Tibial spine fractures which cannot be reduced require operative treatment using either arthroscopic or open reduction and stabilization without injuring the growth plate. Intraligamentous ACL injuries are increasingly observed in children and adolescents. The risk of meniscus tears or chondral damage is high in these injuries. In case of persistent ACL instability, early reconstruction is recommended. Various techniques have been described; however, there is no consensus regarding the most favorable technique. The attending physician must be familiar with different ACL reconstruction techniques and with the anatomy of the growth plate. Meniscus tears require early suturing. Healing rates are good in children.

Experimental production of bending and radial flake fractures and implications for lithic technologies

Bend and radially broken flake tools have been identified in Paleolithic and Paleoindian assemblages, and their presence raises important questions. Were these breaks intentionally produced to serve as tool edges or were broken flakes simply scavenged? More importantly, can we distinguish between intentionally produced breaks and those produced incidentally? Experimental archaeology can help answer these questions. In this paper, three sets of experimentally produced bend and radial flake breaks were compared. Flakes were intentionally broken by percussion, and these breaks were compared to those produced during bifacial core reduction and by flake trampling. The presence of point of impact markers, near ninety degree break angles, and an assemblage with high percentages of bend and radial breaks distinguish intentional fracture from incidental fractures produced during bifacial reduction. High percentages of radial breaks distinguish intentional fracture from trampling. Finally, it may not be possible to identify intentional breaks in a bifacial reduction assemblage severely affected by flake-on-flake trampling.

Zur Behandlung der flake fracture des Talus

This is a report on 18 osteochondral lesions of the talar dome after sprained ankles and ruptured lateral collateral ligaments of the ankle. They were classified according to Berndt & Harty. The treatment of choice in recent flake fractures is the reduction and glueing with fibrine. Very good results were obtained according to Weber. The recommended treatment of ancient flake fractures frequently occurring to elder patients is the removal of the fragment and the drilling of the subchondral bone.

Surgical aspects of the hindfoot MR anatomy

The extent of soft tissue trauma in hindfoot injury (calcaneus fracture, talus fracture) is currently being underestimated. A standardization of magnetic resonance (MR) imaging of the hindfoot is necessary for better definition of pathological changes. Standardized MR imaging projections of the hindfoot were illustrated by anatomic analysis of specimen sections using the same sectional plane as in MR imaging. The plastinated sections were obtained from the same specimen that had been scanned previously. MR imaging of the hindfoot enables the assessment of the calcaneocuboid ligament, the interosseous talocalcaneal ligament, trauma of the foot sole, intraosseous and extraosseous vascularization, muscle compartments in the evaluation of compartment syndrome, chondrai flake fractures, tendon dislocation, as well as tendon degeneration, and plantar fasciitis. These anatomical structures, which must be evaluated for preoperative planning, can be identified clearly by MR imaging.

Classification and Documentation of Children's Fractures

It is absolutely necessary to classify children's fractures for quality controls and clinical research. It is not possible that a classification of children's fractures will follow hierarchies, such as the prognosis of growth, the kind of treatment, the severity of the lesion, the patient's age, as well as medical expenditures and different techniques of therapy. The prognosis of growth is dependent on the patient's age and the localisation of the fracture in the bone and in the skeleton. The kind of treatment is dependent on the extent of displacement as well as on the localisation in the bone. Thus, a classification of children's fractures can only be characterized by the localisation of the fracture and the morphology. In addition, a parameter of “tolerable displacement” should be involved in the classification – as a sign for the possibility of spontaneous correction of displacements by further growth. From the morphological/functional point of view, the epiphyseal plate injuries should be differentiated into a metaphyseal part without proliferation but with mineralisation potential, and an epiphyseal part with proliferation but without mineralisation potential. From this aspect of functional morphology the epiphyseal separation – as a lesion in the metaphyseal part of the physis – belongs to the metaphyseal fractures (so to speak, it is the most peripheral shaft fracture), and the epiphyseal fracture – as a lesion in the epiphyseal part of the physis – belongs to the joint fractures. The localisation is differentiated into 4 main segments: upper arm, forearm, femur, and lower leg. In the segment itself, a subdivision is made into proximal, middle, and distal, with proximal and distal being further differentiated in metaphysis and epiphysis. In addition, it is possible to differentiate between radial and ulnar and tibial and fibular. The morphology is differentiated into typical fractures of the epiphysis, the metaphysis and the shaft fractures as well as avulsion fractures of ligaments, avulsion fractures of muscles and flake fractures. Exceptions in the consequent classification of morphology are only made at the distal end of the humerus and at the neck of the femur. the parameter of “tolerable displacement” showes up already known “ spontaneous corrections” of displacements in the joints, the metaphysis and the epiphysis. The proposed classification should be used in prospective clinical studies to evaluate the prognosis of growth and the results of different therapeutic approaches.

Osteochondritis dissecans tali: Diagnosis and therapy

Osteochondritis dissecans tali (ODT) is still considered a joint disease and is therefore treated primarily as a problem of the joint. It has been suggested that it should be considered as a separate disease resulting from an intra-osseous ganglion. ODT must be distinguished from traumatic flake fractures. By treating ODT as a bone problem and carrying out extra-articular debridement of the ganglion and a cancellous bone graft we achieved out of eight cases, four excellent, three good and one poor result. In all cases the cancellous bone graft was consolidated and the joints were congruent and non-arthritic. The diagnostic technique is also discussed herein: the most useful method is conventional radiography. If additional information is needed about size and location of the lesion, a computed tomography (CT) scan should be used.

Bioresorbable Pins and Screws in Paediatric Traumatology

Bioresorbable implants are suited to the treatment of joint and shaft fractures in children. These conclusions were drawn from clinical and experimental investigations at the University of Heidelberg. Since 1990 13 fractures, including 5 medial malleolus fractures, 2 retropatella flake fractures, 1 metacarpal fracture, 2 lateral condyle, 2 epicondyle fractures and a secondary dislocated forearm fracture were treated with BIOFIX pins. 11 of these cases were without complications. There was one case of infection, and due to material failure the stability was insufficient in one case. In a post-mortem study torsional fractures were produced in femora of children between 5 and 15 months. The fractures were then fixed with one resorbable screw and put under torsional loading until the bone refractured. The post-fixation force (torsional) amounted to 77% of the original fracture force, and the degree of rotation at fracture was post-fixation 84% of the original. The stability of bioresorbable screws in the treatment of femoral spiral fractures in children can therefore be confirmed.

Late carpal instability associated with dorsal distal radial fracture

Carpal instability has been recognized for two decades (Taleisnik, 1988). It is defined as a ‘carpal injury in which loss of normal alignment of the carpal bones develops early or late’. Four distinct patterns can be recognized, of which dorsiflexion intercalated segment instability (DISI) is the commonest. Although late development of the DISI deformity is well recognized, we present a case with radiological signs which have been hitherto unreported and may lead to earlier recognition of the patient at risk. A Lo-year-old man fell 2 m off a ladder onto both outstretched hands. He suffered a Barton’s fracture of the right radius and a small avulsion fracture of the dorsal aspect of the left radius, associated with two flake fractures which appear to have come from the dorsum of the capitate. The proximal fragment appears old with rounded edges. The age of the tiny distal fragment could not be determined. He denied any important trauma to the wrist in the past, but we also noted a probable old ulnar styloid fracture (Figure I). The right wrist was successfully fixed internally with a

Refixation in osteochondrosis dissecans with resorbable material using magnetic resonance tomography in follow-up monitoring

A new method for refixation of osteochondritis dissecans and osteochondral flake fractures by using absorbable pins, fibrin adhesive and autologous spongiosa transplantation is described. The diagnostics can be improved by using MR (magnetic resonance imaging) to demonstrate the preoperative status of the defect as well as the postoperative reintegration of the flake, bone vitality and continuity of the joint cartilage. MR information is an excellent addition to the conventional radiograms for preoperative planning as well as for postoperative decision when to allow daily and sports activities. The clinical and radiological preliminary results of the described method show a complete reintegration in all cases of osteochondritis dissecans of the femur condyle.

Ski injuries, the significance of flake fractures

All patients returning from skiing holidays who had sustained injuries of the knee ligaments were assessed. Thirteen patients had radiologically evident flake fractures around the knee. Of these, all had marked laxity when examined under anaesthetic. In ten cases the accident had occurred at low speed. It is concluded that all knee injuries following a skiing fall must be examined to exclude ligament laxity. The relevance of the bony flakes is discussed.

Arthroscopic treatment of transchondral talar dome fractures

Flake fractures of the talar dome involving the cartilaginous surface and subchondral bone have been called transchondral talar dome fractures, a term specific for both anatomical and traumatic etiology of this lesion, and more descriptive than the previously used “osteochondritis dissecans” of the talus. The diagnosis is made by standard ankle radiographs and the lesion should be suspected in all “sprained ankles” that have continued disability following standard treatment. Surgical treatment has been recommended for Stage 3 and Stage 4 (detached/displaced fragments). Surgical treatment for removal of symptomatic lesions has, in the past, involved an arthrotomy for exposure with removal of the fracture fragment and curetting and drilling of the donor bed. Posteromedial fractures are often hard to reach through a standard approach and exposure may require an osteotomy of the medial malleolus. The use of the arthroscope in both confirmation of diagnosis and surgical treatment has proved to be beneficial in the treatment of these symptomatic fractures. The technique allows direct visualization of the pathology with adequate debridement with minimal iatrogenic trauma and early mobilization and return to preinjury status. The series includes 10 ankles in nine patients with eight posteromedial lesions, six Stage 3 and two Stage 4, and two anterolateral lesions, both Stage 4. All patients were treated arthroscopically for removal of the loose fragment and curettage of the osteochondral bed. Subjective and objective follow-up at a minimum of 6 months revealed good results in nine of the ten patients.