Segond Fracture
Other Names
- Segund Fracture
- Lateral capsular sign
Introduction
General
- Avulsion fracture from the lateral tibial plateau of the knee
- Seen immediately below the articular surface of the tibia on PA radiographs
- Associated with a tear of the anterior cruciate ligament
- Thought to occur due to avulsion of the anterolateral ligament
- Should not be confused with the Arcuate Sign, which has a similar radiographic appearance
History
- First described by Paul Ferdinand Segond, French surgeon (1851-1912) based on cadaveric experiments[2]
Clinical Presentation
- Mechanism of Segond fracture usually occurs with internal rotation, varus stress
- Examples include falls and sports such as soccer, skiing, basketball, baseball
Radiographic Features
- Best seen on the anterior-posterior view of the knee
- Appears as a curvilinear or elliptical bone fragment parallel to the lateral aspect of the tibial plateau
Pathology
- Exact cause of fracture is somewhat contentious
- Historically, taught to be avulsion of middle third of lateral capsular ligaments[3]
- Iliotibial Band, anterior oblique band of fibular collateral ligament have also been implicated[4]
- Anterolateral Ligament was implicated in a 2017 consensus paper[5]
- Not pathognomonic, case reports of segond fracture with intact ACL[6]
Evidence
- Kushare et al[7]
- 73.6% of patients had an ACL tear in pediatric and adolescent patients
- Helito et al[8]
- Anterolateral ligament was abnormal in 64.5% of cases
See Also
References
- ↑ Fernandes, Levi Reina, et al. "Combined ACL reconstruction and Segond fracture fixation fails to abolish anterolateral rotatory instability." Case Reports 2018 (2018): bcr-2018.
- ↑ Segond P. "Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse". Progres Med 1879; 7:297–99, 319–21, 340–41.
- ↑ Humza Shaikh, Elmar Herbst, Ata Amir Rahnemai-Azar, Marcio Bottene Villa Albers, Jan-Hendrik Naendrup, Volker Musahl, James J. Irrgang, Freddie H. Fu. The Segond Fracture Is an Avulsion of the Anterolateral Complex:. (2017) The American Journal of Sports Medicine. 45 (10): 2247-2252. doi:10.1177/0363546517704845
- ↑ Roberts CC, Towers JD, Spangehl MJ et-al. Advanced MR imaging of the cruciate ligaments. Radiol. Clin. North Am. 2007;45 (6): 1003-16, vi-vii. doi:10.1016/j.rcl.2007.08.007
- ↑ Bertrand Sonnery-Cottet, Matthew Daggett, Jean-Marie Fayard, Andrea Ferretti, Camilo Partezani Helito, Martin Lind, Edoardo Monaco, Vitor Barion Castro de Pádua, Mathieu Thaunat, Adrian Wilson, Stefano Zaffagnini, Jacco Zijl, Steven Claes. Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee. (2017) Journal of Orthopaedics and Traumatology. 18 (2): 91. doi:10.1007/s10195-017-0449-8
- ↑ Wharton, R., et al. "Segond fracture in an adult is not pathognomonic for ACL injury." Knee Surgery, Sports Traumatology, Arthroscopy 23 (2015): 1925-1928.
- ↑ Kushare, Indranil, et al. "High incidence of intra-articular injuries with segond fractures of the tibia in the pediatric and adolescent population." Journal of Pediatric Orthopaedics 41.8 (2021): 514-519.
- ↑ Helito, Paulo Victor Partezani, et al. "Magnetic resonance imaging evaluation of the anterolateral ligament and the iliotibial band in acute anterior cruciate ligament injuries associated with Segond fractures." Arthroscopy: The Journal of Arthroscopic & Related Surgery 36.6 (2020): 1679-1686.