Reverse segond fracture almost always result from high energy trauma to the knee and usually affect young adults. Ankle fractures symptoms, diagnosis and treatment bmj. Sep 24, 20 basic principles of fracture management 1. However, the anatomy of the softtissue attachments responsible for the avulsion of sfs has been a cause of controversy. Reverse segond fracture, as its name suggests, is caused by abnormal valgus, or knockknee, stress and external rotation.
Reverse segond fracture without pcl injury semantic scholar. Twenty patients 16 male, 4 female with a combined acl tearuntreated segond fracture with a mean age of 26. Reverse segond fracture associated with anteromedial tibial rim and tibial attachment of. Segond fracture with anterior cruciate ligament tear in an. Open sf fixation and arthroscopic acl reconstruction were performed. Reverse segond fracture associated with anteromedial. Hulstyn, md abstract anterior cruciate ligament acl rupture is a common knee injury and an understanding of current medical knowledge regarding its management is essential. The segond fracture is an unusual fracture that is important to recognize because it is often associated with anterior cruciate ligament disruption and anterolateral instability. If a fracture is suspected, the hip and ankle joints should be examined, as should the legs neurovascular status. Usually, your sports medicine orthopedist can diagnose an acl tear by history and physical exam alone. Hess t, rupp s, hopf t, gleitz m and liebler j, 1994. The arthroscopical and radiological correlation of lever sign test for the diagnosis of anterior cruciate ligament rupture. Avulsion fracture at the tibial insertion of the deep component of the medial collateral ligament is a rare.
May be associated with a dislocation of the ankle joint. Reverse segond fracture is one of these fractures and it should alert the physicians for further diagnostic imaging and proper care for the patient. Pdf surgical treatment of segond fractures in acute anterior. Combined acl reconstruction and segond fracture fixation fails to abolish anterolateral rotatory instability levi reina fernandes,1 herve ouanezar,1 adnan saithna, 2,3 bertrand sonnerycottet1,4 findings that shed new light on the possible pathogenesis of a disease or an adverse effect to cite. In adolescents, the appearance of segond fracture has not been previously reported in. Article information, pdf download for is treatment of segond fracture necessary with. To ensure comprehensive management and continuity, the following nice guidance should be referred to when developing a complete programme of care for. 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. Reverse segond fracture associated with anteromedial tibial rim and tibial attachment of anterior cruciate ligament avulsion fractures yehiah. Segond fracture avulsion fracture of the proximal lateral tibia is pathognomonic for an acl tear. There is a vertical avulsion fracture of the lateral aspect of the proximal tibia black arrow. Feb 22, 2017 this is a case of a year old girl who presented with sudden onset knee pain while playing soccer. We read the article entitled is treatment of segond fracture necessary with combined anterior cruciate ligament reconstruction by melugin et al. 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.
Basal skull fractures are most frequently diagnosed by clinical findings, making clinical assessment skills critical. Initially described following cadaveric studies in the late 19th century by dr. Segond fracture, lateral capsular ligament, anterior cruciate ligament, knee. Can be associated with a disruption of the tibiofibular syndesmosis. Sometimes xrays will show a segond fracture which is a pathognomonic sign on an xray of an acl tear. Unlike previous reports, the combination of reverse segond fracture, anteromedial tibial rim fracture. Reverse segond fracture associated with anteromedial tibial. The reverse segond fracture was first reported by hall and hochman in 1997. In treating a fracture, the objectives of the treatment are as follows. Segond fracture is a small avulsion fracture from the lateral aspect of the.
According to some authors, this fracture is a sign of a lateral damage and can be associated with a total acl disruption in a high percentage of cases 75100%. A small avulsion fracture from the directly lateral surface of the lateral tibial condyle results from excessive tension on the lateral capsular ligament of the knee joint. It is defined as cortical avulsion fracture off the medial tibial plateau of the knee. Pdf background the segond fracture is an avulsiontype fracture located on the anterolateral aspect of the tibia associated with a ligament recently. We describe three cases of a similar fragment on the opposite medial aspect of the proximal tibia representing an. Adolescent segond fracture with an intact anterior cruciate. This is highly associated with acl and meniscal tears. Ultrasound imaging mri 3 6 % reference 1 x ray 9 % ref 2 ultrasound 28 % ref 3 reference reference 1 resnick. A frontal radiograph of the knee demonstrates an avulsion fracture of. Tibial plateau fractures are notoriously difficult to manage, particularly when there is a medial or posteromedial component.
Jul 01, 2012 the segond fracture, also referred to as a lateral capsular sign or a lateral tibial plateau avulsion fracture, implies disruption of the meniscotibial portion of the middle onethird of the. Bumper fracture segond fracture gosselin fracture toddlers fracture pilon fracture plafond fracture tillaux fracture. Segond fracture, fixation burt klos icone the netherlands. The all injury is associated with a segond fracture, and often occurs in conjunction with acute anterior cruciate ligament acl injury.
Segond fracture present in 37% of all acl ruptures, although there is an acl injury present in 75100% of the segond fractures. A case of anterior cruciate ligament disruption in a patient with an avulsion fracture of the lateral proximal tibia is presented. The segond fracture sf is considered pathognomonic of an anterior cruciate ligament acl tear. Reverse segond fracture and associated knee injuries. Primary injury plain x ray information avulsion lesions are a possible goal for refixing important lateral structures. Segond fracture with intra operative signs of displacement. A case jagandeep singh virk abstract the case is a variant of reverse segond fracture which involves injury to the anterior tibial condylar region in addition to the usually involved posterior cruciate ligament pcl and medial collateral ligament mcl injury.
They also debate the value of the ottawa knee rules in kids, nonaccidental trauma, pediatric orthopedic pain management, the evidence for the best management of buckle, greenstick, salter 1 and 2 distal radius fractures and lateral malleolus fractures. Reverse segond fracture is originally described as an indirect radiographic clue for a specific injury complex of the knee joint that includes posterior cruciate ligament pcl rupture and medial meniscal tear. The clinical examination of a traumatically painful knee is often difficult. It is the opposite of the segond fracture, which involves the lateral proximal tibia. On the frontal knee radiograph, it may be referred to as the lateral capsular sign.
Anterolateral ligament expert group consensus paper on the. The segond fracture is an avulsion fracture involving the proximal tibia immediately distal to the lateral plateau. History 1845 amedee bonnet published the first cadaveric studies for the mechanism of knee ligament injuries. Reverse segond fracture radiology reference article. Xrays are usually taken as a screening exam to make sure there is no fracture. This was associated with a serious injury to the posterolateral corner requiring surgical reconstruction. The authors mentioned that the segond fracture was at the site of the. Traumatic fracture can be transverse, oblique, spiral, displaced.
Segond fractures, or avulsion fractures of the proximal lateral tibial plateau, have been well documented and studied since their original description in 1878. Nov 19, 2008 segonds fracture is an avulsion fracture of the lateral rim of the tibial plateau. Bedeir orthopedic surgery department, elhadara university hospital, university of alexandria, alexandria, egypt. Pdf surgical treatment of segond fractures in acute. Pdf on apr 1, 2018, etienne cavaignac and others published is treatment of segond fracture necessary with combined anterior cruciate ligament. Because of the high rate of associated ligamentous and meniscal injury, the presence of a segond or reverse segond. Chung, nittaya lektrakul, robert pedowitz, debra trudell, joseph yu, donald resnick. A segond fracture is often thought to be pathognomonic for an acl injury. It was described by paul segond in 1879, in cadaveric experiments, as a cortical avulsion of the tibia at the site of insertion of the middle third of the lateral capsular ligament lcl. Hess et al 1994 found that of 151 patients with acl lesions, 9% had segond fractures, whereas control group there was 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. The mechanism of injury is internal rotation and various stresses, which causes abnormal tension on the central portion of the lateral capsular ligament. In adult patients with segond fracture on plain film acl and lcl tears should be assumed unless proven otherwise. Post, md n 1879, paul segond, using cadaveric knees, demonstrated that excessive tibial internal rotation with the knee flexed produced an avulsion fracture of the lateral tibial condyle in 17 of 38 knees 10.
Avulsion fractures in the appendicular skeleton are a result of stress on a specific structure that is firmly attached to bone. Check the xray for a segond fracture, a vertically oriented avulsion fracture off the lateral proximal tibia. 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. Post, md n 1879, paul segond, using cadaveric knees, demonstrated that excessive tibial internal rotation with the knee flexed produced an avulsion fracture of the lateral tibial condyle in.
Segond fractures typically occur by forced internal tibial rotation with the knee flexed. Although not directly a part of the knee joint, it occurs in association with tears of the anterior cruciate ligament acl, medial meniscus and lateral capsular ligament, and is thus included here. For this reason the segonds fracture is considered a helpful sign for the diagnosis of acl ruptures. The iliotibial tract, also known as maissiats band or the iliotibial band, and its associated muscles function to extend, abduct, and laterally rotate the hip, as well as aid in the stabilization of the knee. We report a reverse segond fracture associated with anterior cruciate ligament tibial avulsion fracture and anteromedial tibial rim fracture. The segond fracture or lateral capsular sign is a scalelike bone fragment of the lateral tibial plateau. Segond fracture litfl medical blog medical eponym library. Segond fractures, diagnosis and treatment burt klos icone the netherlands. Management is usually surgical to repair the spring ligament or otherwise aggressive orthotics spring ligament avulsion. Physicians diagnosing and managing knee injuries have become familiar with the lateral capsule sign, or segond fracture on radiography.
Is treatment of segond fracture necessary with combined. Surgical treatment of segond fractures in acute anterior cruciate. The segond fracture is an avulsion fracture of the lateral tibial plateau and is considered pathognomonic for anterior cruciate ligament acl injury. Essentials of anterior cruciate ligament rupture management. Mar 20, 20 patients with segond fracture require close orthopedic follow up for presumed ligamentous injury in addition to the usual rice, crutches, nwb, knee immobilizer. Anterolateral ligament expert group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament. It is described as a capsular sign of associated anterior cruciate ligament acl tears. Anatomic and clinical findings suggest that fibers of the itt and aob are important factors in the pathogenesis of the segond fracture. A segond fracture is an avulsion of the laterial ubial rim cortex secondary to avulsion of the lateral capsular ligament. Herein, we describe a case with reverse segond fracture associated with pcl avulsion fracture instead of pcl rupture. Early recognition prompts a more thorough evaluation and management of. This is a case of a year old girl who presented with sudden onset knee pain while playing soccer.
Anatomic and mr imaging evidence of an iliotibial tract or anterior oblique band avulsion. A frontal radiograph of the knee demonstrates an avulsion fracture of the lateral tibial plateau. Deveci a, cankaya d, yilmaz s, ozdemir g, arslantas e, bozkurt m. Paul segond, the segond fracture is now widely accepted as a pathognemonic radiographic marker of anterior cruciate. Is treatment of segond fracture necessary with combined anterior. Accurate and prompt diagnosis requires an awareness. Basic principles of fracture management slideshare.
Clinical analysis of acute segond fractures confirmed the frequent attachment of the itt and aob to the avulsed fragment. A case of a segond fracture occurring with a clinically, radiologically and arthroscopically intact acl is presented. All content, including text, graphics, images and information, contained on or available through this siteblog is for medical education only. Interesting xrays seemingly insignificant but clinically. Basilar skull fractures are usually due to significant trauma.
Segond fracture in an adult is not pathognomonic for acl. It further shows the importance of recognition of the medial tibial avulsion fracture as an indicator of more severe internal derangement and instability of the knee. When this type of injury is diagnosed, the radiologist should consider posterior cruciate ligament injury and peripheral medial meniscal tears as possible associated. Bone marrow adjacent to the fracture emitted a focally abnormal mr signal, which indicated an injury of the lateral capsular junction. A 31yearold male patient presented with an injury to his right knee that resulted in acl tear and a sf. 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. Reverse segond fracture is an uncommon avulsion fracture of the tibial attachment of the deep portion of the medial collateral ligament of the knee. Although there is an acl injury in 75100% of the segond fractures, the segond fracture itself is only present in 37% of. Adolescent segond fracture with an intact anterior. Reverse segond fracture is one of the avulsion fracture of the knee, which is due to avulsion of the deep fibers of the medial collateral ligament also known as the menisciotibial or coronary ligament involving the medial proximal tibia adjacent to the articular surface. Reverse segond fracture is one of the avulsion fracture of the knee, which is due to avulsion of the deep fibers of the medial collateral ligament also known as the menisciotibial or coronary ligament involving the medial proximal tibia adjacen. 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. Aug 16, 2008 according to some authors, this fracture is a sign of a lateral damage and can be associated with a total acl disruption in a high percentage of cases 75100%.
The fracture is considered pathogonomic for acl tears. The information on this siteblog is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. This case involves a unique reverse segond fracture pattern with acl and mcl tears that does not have the usually involved pcl tear or obvious meniscal tear. Segond fracture, hemarthrosis, and anterior cruciate ligament. In adolescents, the appearance of segond fracture has not been previously reported in association with acl intrasubstance tear. A segond fracture is a small bone avulsion from the lateral aspect of the tibia.
An avulsion fracture of the anterolateral margin of the lateral tibial plateau, associated with anterior cruciate ligament acl tears. The segond fracture is an avulsiontype fracture located on the anterolateral aspect of the tibia associated with a ligament recently termed the. A select group of associated injuries and pathologies of the iliotibial tract are seen as sequela of repetitive stress and direct trauma. Essentials of anterior cruciate ligament rupture management stephen a. Commonly a lowenergy fracture of either the lateral or medial malleolus, or both, and can include a fracture of the posterior malleolus. The treatment for tibial plateau fractures aims to achieve anatomical reduction of the joint surface and stable osteosynthesis in order to enable early mobilization, so as to prevent complications such as joint stiffness. The segond fracture is considered highly suggestive of an. Segond fracture is typically the result of abnormal varus, or bowing, stress to the knee, combined with internal rotation of the tibia. Paul segond, the segond fracture is now widely accepted as a pathognemonic radiographic marker of anterior cruciate ligament injury. This fracture is significant because it has a strong association with acl injuries. Surgical treatment of segond fractures in acute anterior cruciate ligament reconstruction article pdf available in the orthopaedic journal of sports medicine 510. Reverse segond fracture without pcl injury sciencedirect. 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. The mechanism of injury is internal rotation and various stresses, which causes abnormal tension.
773 1064 1168 681 1404 1534 98 1246 668 1313 255 7 200 895 411 105 1168 871 777 1195 321 686 752 1110 227 544 1349 1361 243 137 591 1353 1492 1285 773 659 419 975 1525 715 1053 1340 1224 686 208 957 699 339