CASE 12 – NOT THE FIRST MISSED STEP

50 year old running down stairs stumbled and missed last 2 steps and landed on right knee.  She  felt a pop in her right knee.

Xray:

Diagnosis:

Segond Fracture:  A lateral tibia plateau avulsion fracture.

Recent literature suggests that it may be an avulsion injury of the anterolateral ligament (ALL). The ALL attaches the lateral femoral epicondyle to the lateral tibial plateau. 1  However previously thought to be either a lateral capsular avulsion or potentially an ITB avulsion injury.

Figure 2: Close up of Segond Fracture

What injury is assoicated with this?

Anterior Cruciate Ligament tear.

What other radiograph signs are there of this injury?

Segond Fracture

Tibial Spine avulsion

Lateral Impaction Fracture/Lateral femoral notch sign

Arcuate sign – posterolateral corner injury (90% associated with curciate ligament injury)2

Cupola sign – Chronic ACL – posteromedial tibial osteophyte (Also femoral notch narrowing and tibia spine peaking.2

Author Dr. Neil Dilworth (July 13, 2017)

References:

1. Claes S, Luyckx T, Vereecke E, Bellemans J. The Segond fracture: a bony injury of the anterolateral ligament of the knee.Arthroscopy. 2014. Epub ahead of print.
2. Johnson, D L; Brunkhorst, J; Johnson, D L.

Radiographic evidence of anterior cruciate ligament insufficiency.

Source  Orthopedics. 37(11):759-62, 2014 Nov.