what’s a Segond Fracture?

7 Jul
(re-post, but came up again recently on a shift, figured this’d be a good refresher)
RAGING HYPOTHETICAL:
 
28 y/o male presents after falling while playing soccer.
 
His left knee became swollen and difficult to use soon after the injury. He was able to ambulate for a few steps after it happened but reported it did not feel normal.
 
On exam the patient has a swollen and warm left knee. There is no point tenderness and no joint laxity compared to the uninjured side.
 
Plain film of the knee reveals:
 
 
KEY POINTS:
 
See the small avulsion of the lateral tibia? This radiographic finding is known as a Segond Fracture.
 
The small tibial avulsion is due LCL rupture.  

The force required to cause this injury is severe and is usually associated with further ligamentous injury in the knee. In one small case series:
  • 9 of 9 patients with Segond fracture had LCL and ACL tear
  • 6/9 had meniscal tears as well.
 
Patients with Segond Fracture require close orthopedic follow up for presumed ligamentous injury (in addition to the usual RICE, crutches, NWB, knee immobilizer).
 
In adult patients with Segond Fracture on plain film ACL and LCL tears should be assumed unless proven otherwise.

Submitted by L. Cunningham.
 
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Reference:  AB Goldman, H Pavlov and D Rubenstein, American Journal of Roentgenology 1988 151:6, 1163-1167
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