Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2015

01-07-2015 | Knee

Segond fracture in an adult is not pathognomonic for ACL injury

Authors: R. Wharton, J. Henckel, G. Bhattee, S. Ball, S. Church

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2015

Login to get access

Abstract

The Segond fracture is an avulsion fracture of the lateral tibial plateau and is considered pathognomonic for anterior cruciate ligament (ACL) injury. A case of a Segond fracture occurring with a clinically, radiologically and arthroscopically intact ACL is presented. This was associated with a serious injury to the posterolateral corner requiring surgical reconstruction. Relevant literature is discussed, and the suggestion is made that, whilst an ACL rupture may be the most commonly noted soft tissue component associated with a Segond fracture, the clinician should have a high level of suspicion for other serious soft tissue injuries.
Level of evidence V.
Literature
1.
go back to reference Arneja SS, Furey MJ, Alvarez CM, Reilly CW (2010) Segond fractures: not necessarily pathognomonic of anterior cruciate ligament injury in the pediatric population. Sports health 2(5):437–439PubMedCentralPubMed Arneja SS, Furey MJ, Alvarez CM, Reilly CW (2010) Segond fractures: not necessarily pathognomonic of anterior cruciate ligament injury in the pediatric population. Sports health 2(5):437–439PubMedCentralPubMed
2.
go back to reference Bathala EA, Bancroft LW, Ortiguera CJ, Peterson JJ (2007) Radiologic case study. Segond fracture. Orthopedics 30(9):688–797 Bathala EA, Bancroft LW, Ortiguera CJ, Peterson JJ (2007) Radiologic case study. Segond fracture. Orthopedics 30(9):688–797
3.
go back to reference Bock GW, Bosch E, Mishra DK, Daniel DM, Resnick D (1994) The healed Segond fracture: a characteristic residual bone excrescence. Skeletal Radiol 23(7):555–556PubMedCrossRef Bock GW, Bosch E, Mishra DK, Daniel DM, Resnick D (1994) The healed Segond fracture: a characteristic residual bone excrescence. Skeletal Radiol 23(7):555–556PubMedCrossRef
4.
go back to reference Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr (2000) Mechanisms of anterior cruciate ligament injury. Orthopedics 23(6):573–578PubMed Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr (2000) Mechanisms of anterior cruciate ligament injury. Orthopedics 23(6):573–578PubMed
5.
go back to reference Boden BP, Sheehan FT, Torg JS, Hewett TE (2010) Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. J Am Acad Orthop Surg 18(9):520–527PubMedCentralPubMed Boden BP, Sheehan FT, Torg JS, Hewett TE (2010) Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. J Am Acad Orthop Surg 18(9):520–527PubMedCentralPubMed
6.
go back to reference Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D (2001) Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology 219(2):381–386PubMedCrossRef Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D (2001) Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology 219(2):381–386PubMedCrossRef
8.
go back to reference Cosgrave CH, Burke NG, Hollingsworth J (2012) The Segond fracture: a clue to intra-articular knee pathology. Emerg Med J 29(10):846–847PubMedCrossRef Cosgrave CH, Burke NG, Hollingsworth J (2012) The Segond fracture: a clue to intra-articular knee pathology. Emerg Med J 29(10):846–847PubMedCrossRef
9.
go back to reference Davis DS, Post WR (1997) Segond fracture: lateral capsular ligament avulsion. J Orthop Sports Phys Ther 25(2):103–106PubMedCrossRef Davis DS, Post WR (1997) Segond fracture: lateral capsular ligament avulsion. J Orthop Sports Phys Ther 25(2):103–106PubMedCrossRef
10.
go back to reference Dietz GW, Wilcox DM, Montgomery JB (1986) Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology 159(2):467–469PubMedCrossRef Dietz GW, Wilcox DM, Montgomery JB (1986) Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology 159(2):467–469PubMedCrossRef
11.
go back to reference Fauno P, Wulff Jakobsen B (2006) Mechanism of anterior cruciate ligament injuries in soccer. Int J Sports Med 27(1):75–79PubMedCrossRef Fauno P, Wulff Jakobsen B (2006) Mechanism of anterior cruciate ligament injuries in soccer. Int J Sports Med 27(1):75–79PubMedCrossRef
12.
go back to reference Feagin JA Jr, Lambert KL (1985) Mechanism of injury and pathology of anterior cruciate ligament injuries. Orthop Clin North Am 16(1):41–45PubMed Feagin JA Jr, Lambert KL (1985) Mechanism of injury and pathology of anterior cruciate ligament injuries. Orthop Clin North Am 16(1):41–45PubMed
13.
go back to reference Felenda M, Dittel KK (1992) Importance of the Segond avulsion fracture as a sign of complex ligamentous knee injury. Aktuelle Traumatol 22(3):120–122PubMed Felenda M, Dittel KK (1992) Importance of the Segond avulsion fracture as a sign of complex ligamentous knee injury. Aktuelle Traumatol 22(3):120–122PubMed
14.
go back to reference Geyer M, Wirth CJ (1991) A new mechanism of injury of the anterior cruciate ligament. Unfallchirurg 94(2):69–72PubMed Geyer M, Wirth CJ (1991) A new mechanism of injury of the anterior cruciate ligament. Unfallchirurg 94(2):69–72PubMed
15.
go back to reference Goldman AB, Pavlov H, Rubenstein D (1988) The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. Am J Roentgenol 151(6):1163–1167CrossRef Goldman AB, Pavlov H, Rubenstein D (1988) The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. Am J Roentgenol 151(6):1163–1167CrossRef
16.
go back to reference Hess T, Rupp S, Hopf T, Gleitz M, Liebler J (1994) Lateral tibial avulsion fractures and disruptions to the anterior cruciate ligament. A clinical study of their incidence and correlation. Clin Orthop Relat Res 303:193–197PubMed Hess T, Rupp S, Hopf T, Gleitz M, Liebler J (1994) Lateral tibial avulsion fractures and disruptions to the anterior cruciate ligament. A clinical study of their incidence and correlation. Clin Orthop Relat Res 303:193–197PubMed
17.
go back to reference Irvine GB, Dias JJ, Finlay DB (1987) Segond fractures of the lateral tibial condyle: brief report. J Bone Joint Surg Br 69(4):613–614PubMed Irvine GB, Dias JJ, Finlay DB (1987) Segond fractures of the lateral tibial condyle: brief report. J Bone Joint Surg Br 69(4):613–614PubMed
18.
go back to reference Johnson LL (1979) Lateral capsular ligament complex: anatomical and surgical considerations. Am J Sports Med 7(3):156–160PubMedCrossRef Johnson LL (1979) Lateral capsular ligament complex: anatomical and surgical considerations. Am J Sports Med 7(3):156–160PubMedCrossRef
19.
go back to reference Kerr HD (1990) Segond fracture, hemarthrosis, and anterior cruciate ligament disruption. J Emerg Med 8(1):29–33PubMedCrossRef Kerr HD (1990) Segond fracture, hemarthrosis, and anterior cruciate ligament disruption. J Emerg Med 8(1):29–33PubMedCrossRef
20.
go back to reference Krosshaug T, Nakamae A, Boden BP, Engebretsen L, Smith G, Slauterbeck JR, Hewett TE, Bahr R (2007) Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med 35(3):359–367PubMedCrossRef Krosshaug T, Nakamae A, Boden BP, Engebretsen L, Smith G, Slauterbeck JR, Hewett TE, Bahr R (2007) Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med 35(3):359–367PubMedCrossRef
21.
go back to reference Milch H (1936) Cortical avulsion fracture of the lateral tibial condyle. J Bone Joint Surg Am 18(1):159–164 Milch H (1936) Cortical avulsion fracture of the lateral tibial condyle. J Bone Joint Surg Am 18(1):159–164
22.
go back to reference Quatman CE, Hewett TE (2009) The anterior cruciate ligament injury controversy: is “valgus collapse” a sex-specific mechanism? Br J Sports Med 43(5):328–335PubMedCentralPubMedCrossRef Quatman CE, Hewett TE (2009) The anterior cruciate ligament injury controversy: is “valgus collapse” a sex-specific mechanism? Br J Sports Med 43(5):328–335PubMedCentralPubMedCrossRef
23.
go back to reference Reddy D, Alexander R, Hussain WM, Leland JM (2012) Adolescent Segond fracture with an intact anterior cruciate ligament. Orthopedics 35(7):1112–1115CrossRef Reddy D, Alexander R, Hussain WM, Leland JM (2012) Adolescent Segond fracture with an intact anterior cruciate ligament. Orthopedics 35(7):1112–1115CrossRef
24.
go back to reference Segond P (1879) Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Bureaux du Progrès Médical, Paris Segond P (1879) Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Bureaux du Progrès Médical, Paris
26.
go back to reference Tei K, Kubo S, Matsumoto T, Matsushita T, Matsumoto A, Kurosaka M, Kuroda R (2012) Combined osteochondral fracture of the posterolateral tibial plateau and Segond fracture with anterior cruciate ligament injury in a skeletally immature patient. Knee Surg Sports Traumatol Arthrosc 20(2):252–255PubMedCrossRef Tei K, Kubo S, Matsumoto T, Matsushita T, Matsumoto A, Kurosaka M, Kuroda R (2012) Combined osteochondral fracture of the posterolateral tibial plateau and Segond fracture with anterior cruciate ligament injury in a skeletally immature patient. Knee Surg Sports Traumatol Arthrosc 20(2):252–255PubMedCrossRef
27.
go back to reference Valkering KP, Breederveld RS (2009) Segond fracture. J Am Coll of Surg 208(4):646CrossRef Valkering KP, Breederveld RS (2009) Segond fracture. J Am Coll of Surg 208(4):646CrossRef
28.
go back to reference Weber WN, Neumann CH, Barakos JA, Petersen SA, Steinbach LS, Genant HK (1991) Lateral tibial rim (Segond) fractures: MR imaging characteristics. Radiology 180(3):731–734PubMedCrossRef Weber WN, Neumann CH, Barakos JA, Petersen SA, Steinbach LS, Genant HK (1991) Lateral tibial rim (Segond) fractures: MR imaging characteristics. Radiology 180(3):731–734PubMedCrossRef
29.
go back to reference Westermann RW, Wolf BR, Wahl CJ (2013) Does lateral knee geometry influence bone bruise patterns after anterior cruciate ligament injury? A report of two cases. Iowa Orthop J 33:217–220PubMedCentralPubMed Westermann RW, Wolf BR, Wahl CJ (2013) Does lateral knee geometry influence bone bruise patterns after anterior cruciate ligament injury? A report of two cases. Iowa Orthop J 33:217–220PubMedCentralPubMed
Metadata
Title
Segond fracture in an adult is not pathognomonic for ACL injury
Authors
R. Wharton
J. Henckel
G. Bhattee
S. Ball
S. Church
Publication date
01-07-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-2965-x

Other articles of this Issue 7/2015

Knee Surgery, Sports Traumatology, Arthroscopy 7/2015 Go to the issue