Segond fracture is probably the best known and most discussed avulsion fracture of the knee. Figure 8a figure 8b findings lateral radiograph of the right knee fig. Discussion when a segond fracture is present one should be very suspicious of an anterior cruciate ligament injury or another significant knee injury. Originally described by the french surgeon paul segond in 1879 after a series of cadaveric experiments, 1, this fracture involves cortical avulsion of the tibial insertion of. Reverse segond fracture is one of these fractures and it should alert the physicians for further diagnostic imaging and proper care for the patient.
Obtain anteroposterior, lateral, and oblique radiographs of the knee. In addition, patients younger than 18 years n 1, patients with an incomplete examination n 1, and those with suboptimal imaging such as that seen with hardware or. The segond fracture is an avulsion fracture of the lateral tibial plateau and is considered pathognomonic for anterior cruciate ligament acl injury. The deep sulcus sign was defined as depth greater than 1. The segond fracture is an avulsion of the anterolateral complex. Interesting cases and teaching files from radiology cases used for educating faculty, fellows and residents. It is not from the lateral collateral ligament, which attaches to the fibular head. The mechanism of injury is internal rotation and varus stress, which commonly believed to cause abnormal tension on the central portion of the lateral capsular ligament. A segond fracture has an associated acl injury 75% to 100% of the time, 3,5 and it occurs in approximately 9% to 12% of all acl tears.
Request pdf high prevalence of all complex segond avulsion using ultrasound imaging purposethe aim of this study was to determine the prevalence of a segond avulsion fractures in acute acl. It is caused by an avulsion from the lateral aspect of. The aim of this study was to determine the prevalence of a segond avulsion fractures in acute acl tears with ultrasound and to investigate whether other injuries can predict the avulsion. Ultrasound shows a higher prevalence of segond avulsions as literature shows with mri or radiography. Twenty patients 16 male, 4 female with a combined acl tearuntreated segond fracture with a mean age of 26. Segond fracture in an adult is not pathognomonic for acl. Magnetic resonance imaging of acute maisonneuve fractures. The anterolateral ligament of the knee irua institutional. Knee fracture management in the emergency department.
In this study, segond repeated the work of amedee bonnet. A 45yearold male presents with right knee pain after he pivoted and felt a pop while making a move playing pickup basketball. Mri was then ordered but was delayed secondary to the orif procedure on the contralateral leg. Reverse segond fracture almost always result from high energy trauma to the knee and usually affect young adults.
Ap image and lateral image mediolateral projection of an intercondylar eminence fracture. Further imaging was recommended to investigate ligamentous or meniscal damage. The aim of this study was to evaluate the effect of a. The imaging database search identified 26 patients diagnosed with a segond fracture. Segond fractures are not a risk factor for anterior.
On the frontal knee radiograph, it may be referred to as the lateral capsular sign. Role of imaging in fractures muhammad bin zulfiqar pgr ii simsshl new radiology department 2. Segond fracture wikimili, the best wikipedia reader. Bone marrow adjacent to the fracture emitted a focally abnormal mr signal, which indicated an injury of the lateral capsular junction. The segond fracture is a type of avulsion fracture soft tissue structures tearing off bits of their bony attachment of the lateral tibial condyle of the knee, immediately beyond the surface which articulates with the femur. To identify the softtissue structure causative for the segond fracture, a study was set up to compare anatomic details of the tibial insertion of the recently characterized all in cadaveric knees n. A bumper fracture is a fracture of the lateral tibial plateau caused by a forced valgus applied to the knee. Avulsion fracture of the lateral tibial plateau immediately distal to the articular surface. All patients had sustained a twisting injury to their ankles and complained of ankle pain and pain over their proximal fibula. We describe three cases of a similar fragment on the opposite medial aspect of the proximal tibia representing an avulsion of the deep capsular component of the medial.
Nissman clinical history 41yearold male with knee pain after a skiing injury. The segond fracture is a type of avulsion fracture soft tissue structures tearing off bits of their bony attachment of the lateral tibial condyle of the knee, immediately beyond the surface which articulates with the femur contents. Segond fractures occur via tension along a variety of structures to a varying degree. A case of a segond fracture occurring with a clinically, radiologically and arthroscopically intact acl is presented. Originally described by the french surgeon paul segond in 1879 after a series of cadaveric experiments, 1, this fracture involves cortical avulsion of the tibial insertion of the middle third of the lateral capsular ligament, 2. Initial radiograph of the injured left knee demonstrated a lipohemarthrosis related to a 10mm separated bony body on the lateral margin of the proximal tibial epiphysis segond fracture figure 1.
Segond fracture, imaging and fixation burt klos icone the netherlands. C pd fs fse sagittal image reveals contusion of posterolateral portion of. High quality images with excellent visualization of all the ankle ligamentous structures were obtained. A 31yearold male patient presented with an injury to his right knee that resulted in acl tear and a sf. The segond fracture is a cortical avulsion fracture of the proximal tibia, located just below the level of the lateral plateau and superior and posterior to the gerdy tubercle. Segond fracture with acl rupture and posterolateral corner injury. A frontal radiograph of the knee demonstrates an avulsion fracture of the lateral tibial. Mri third image bone marrow oedema blue arrow low signal fracture line seen immediately posterior to itb insertion. A segond fracture is a significant injury of the knee. Lfc impaction is the best variable in predicting this type of avulsion. Segond fracture is an avulsion fracture of the knee that involves the lateral aspect of the tibial plateau and is very frequently 75% of cases associated with. Fractures of the knee include fractures of the patella, femoral condyles, tibial eminence, tibial tuberosity, and tibial plateau. Sometimes xrays will show a segond fracture which is a pathognomonic sign on an xray of an acl tear. High prevalence of all complex segond avulsion using.
Jun 21, 2014 the segond fracture was defined as a lateral tibial rim fracture 19, 24. The segond fracture sf is considered pathognomonic of an anterior cruciate ligament acl tear. Anatomic dissection and mr imaging of the cadaveric knees demonstrated a broad tibial insertion of the itt, with fibers extending posterior to the gerdy tubercle. The segond fracture is a subtle vertical avulsion fracture involving the proximal tibia immediately distal to the lateral plateau. While previous studies evaluated the role of the anterolateral ligament all and complex injuries on rotational stability of the knee, there are no studies on the biomechanical effect of segond s fracture in an acl deficient knee. The segond fracture was defined as a lateral tibial rim fracture 19, 24. We describe three cases of a similar fragment on the opposite medial aspect of the proximal tibia representing an. Reverse segond fracture and associated knee injuries. Segond fracture combined with tibial plateau fracture. This is a case of a year old girl who presented with sudden onset knee pain while playing soccer. The incidence of segond fractures was 3 times as common in male patients p.
Should you suffer a major knee injury in a serious accident due to the negligence of another person or entity, call me at 800 4045400 andor 916 9216400 to receive free, friendly legal guidance and advice. Segond fracture fragment size was predictive for the structures attached to it. Mri evaluation of the anterolateral ligament and the. B pd fs fse sagittal image reveals complete discontinuity of acl. This phenomenon, which is easy to detect by radiograph, can thus be regarded as a strong indication of the presence of a ligament injury. Xray shows fracture fragment blue arrow adjacent to lateral tibial plateau. Segond fractures are not a risk factor for anterior cruciate.
An imaginary line drawn along the lateral femoral condyle and the medial cortex of the proximal fibular shaft should not have more than 5mm of tibial condyle located laterally. Segond fracture small avulsed bone fragment from the lateral margin of the tibial plateau. In all combined acl injuries and segond fracture mri cases, the complete all inserted on the avulsed bony fragment, while the posterior part of the itb was only attached in 52. The segond fracture is an important radiographic sign that is critical to recognize because it is generally associated with anterior cruciate ligament disruption. A segond fracture is a small avulsion type fracture of the lateral aspect of the tibial plateau where the lateral capsular ligament avulses a fragment of bone. The segond fracture is an elliptical, vertical, 3 x 10mm bone fragment paralleling the lateral tibial cortex about 4 mm distal to the plateau. Initial knee radiograph demonstrates signs of prior osseous injury ie, segond fracture, tibial spine avulsion, etc. Diagnostic radiologymusculoskeletal imagingtraumasegond. No patients undergoing revision surgery had a segond fracture, and no patient with a segond fracture had graft failure. Segond s fracture is a wellrecognised radiological sign of an anterior cruciate ligament acl tear. The segond fracture is a type of avulsion fracture soft tissue structures pulling off fragments of their bony attachment from the lateral tibial plateau of the knee, immediately below the articular surface of the tibia see photo.
Is treatment of segond fracture necessary with combined. A t2 gre coronal reveals avulsion of the lateral rim of tibial plateau segond fracture arrow. This causes the lateral part of the distal femur and the lateral tibial plateau to come into contact, compressing the tibial plateau and causing the tibia to fracture. An avulsion fracture at the site of attachment of the lateral capsular ligament on the lateral tibial condyle segond fracture is a marker for anterior cruciate ligament rupture. Hess et al 1994 found that of 151 patients with acl lesions, 9% had segond fractures, whereas control group there was segond fracture is probably the best known and most discussed avulsion fracture of the knee. Imaging segond avulsion incidence in mri 3 % resnick usa incidence in x ray corr hess d 9 % incidence ultrasound 29 % icone. Woods et al correlated the segond fracture to the presence of significant knee. Imaging segond avulsion incidence in mri 3 % resnick usa incidence in x ray corr hess. My minicourse on chronic knee pain and acute knee injury. Because of the high rate of associated ligamentous and meniscal. Recherches cliniques et experimentales sur les epanchements sanguins du genou par entorse. Hunters phone number, address, insurance information and more.
This was associated with a serious injury to the posterolateral corner requiring surgical reconstruction. The segond fracture, an avulsion fracture of the lateral joint capsule at its insertion onto the lateral tibial plateau, is associated with an acl tear in 90% of cases when it is present figure 5. Patients with a segond fracture are at no higher risk to require revision acl reconstruction compared with patients without a segond fracture. The radiographic diagnosis is critical, as a segond fracture is typically associated with internal derangement of the knee and further imaging with mri should follow. The reports of patients with an acl tear n 87 were evaluated to determine possible.
Xrays are usually taken as a screening exam to make sure there is no fracture. Our radiology teaching file system tfs is free software developed under the rsna mirc project that gives users the ability to author, manage, store and share radiology teaching files locally or across institutions. The reverse segond fracture is thought to result following external rotation of the knee, with applied valgus stress 1 c. Reverse segond fracture radiology reference article. Avulsion of the proximal, lateral tibia best seen on the anteroposterior view or tunnel view of the knee. A firm band of tissue, the aob, extended from the fibular collateral ligament to the midportion of the lateral tibia, the typical site of a segond fracture. Can magnetic resonance imaging findings predict the degree of. However, the anatomy of the softtissue attachments responsible for the avulsion of sfs has been a cause of controversy.
Segond fracture avulsion of the proximal, lateral tibia best seen on the anteroposterior view or tunnel view of the knee in about 75% of cases, there is an associated injury of the anterior cruciate ligament acl. Adult or child greater than or equal to 5 years of age. Segond fracture is an avulsion fracture of the knee that involves the lateral aspect of the tibial plateau and is very frequently 75% of cases associated with disruption of the anterior cruciate ligament acl tear. This ap xray image shows a segond fracture an avulsion from the lateral tibial condyle. The segond fracture is an avulsion of the lateral capsular ligament, which manifests as an elliptic bony fragment off the lateral proximal tibia, that has a high association with tear of the anterior cruciate ligament 1,2,3. Segond fracture, lateral capsular ligament, anterior cruciate ligament, knee. At the time of primary acl reconstruction, if a segond fracture is identified, it can be ignored not repaired or reconstructed, and this approach does. Avulsion fractures around the knee and their importance. The segond fracture or lateral capsular sign is an avulsion fragment of the lateral tibial plateau, which corresponds to the distal insertion point of the lateral capsular ligament or lateral meniscotibial ligament. One hundred thirtyeight ultrasound analyses of acute knee trauma were collected and scored for diagnosed injuries.
A segond fracture is an avulsion fracture located in the lateral aspect of the tibial plateau of the knee. Unlike the segond, which is often seen with sporting injury, the reverse segond appears to occur with higher velocity injuries, such as being struck by a motor vehicle. Magnetic resonance imaging mri studies were performed on five patients with acute maisonneuve fractures. A rare, mirror image of the segond fracture has also been described the reverse segond fracture, an avulsion off the medial tibia. Gerry gardner at what is the most likely diagnosis, commonly associated injury, and appropriate management plan. The fracture is the result of excessive internal rotation and varus stress and has a high association with tears of the anterior cruciate ligament and menisci, as well. You obtain knee xrays and see a lateral irregularity in the ap view photo courtesy of dr. Jan 24, 2016 a segond fracture see the images below is a stereotypical fracture of the tibia that has a 75100% association with acl tear. Nov 03, 2018 radiograph demonstrates degenerative changes or chondrocalcinosis. A segond fracture is a serious injury of the knee that will take several months to heal. Usually, your sports medicine orthopedist can diagnose an acl tear by history and physical exam alone. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Patients with a segond fracture combined with a tibial plateau fracture. To determine the anatomic characteristics of the segond fracture on plain radiographs and magnetic resonance imaging mri, to compare this.
Paul segond in 1879 after a series of cadaveric experiements, the segond fracture occurs in association with acl tears 75100% and medial meniscal injury 6675%, as well as injury to the posteriolateral knee structures. Hess et al 1994 found that of 151 patients with acl lesions, 9% had segond fractures, whereas control group there was proximal tibial epiphysis segond fracture figure 1. Avulsion at this location is the result of excessive varus stress on the lateral joint capsule. Ultrasound imaging mri 3 6 % reference 1 x ray 9 % ref 2 ultrasound 28 % ref 3 reference reference 1 resnick. Segond and reverse segond fractures are characterized by a small avulsion fragment of characteristic size that is best seen on plain radiography in the ap plane. A segond fracture is an avulsion fracture on the outer side of the lateral tibial plateau and may develop following internal rotation in combination with varus stress fig.
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