Segond fracture

Background

• Avulsion fracture of proximal lateral tibia
• Pathognomic for ACL tear

Clinical Features

ACL

• Hearing/feeling a "pop" during injury with ensuing knee instability is pathognomonic
• Anterior Drawer Sign
  • Pt supine, knee flexed 90', attempt to displace tibia from femur in a forward direction
  • Displacement of >6mm compared w/ opposite knee indicates injury
• Lachman Test (most sensitive)
  • Pt supine, knee flexed 30', femur held w/ one hand, prox tibia pulled up w/ other hand
  • Displacement >5mm or soft end-point indicates injury
• Pivot Shift Test
• Segond Fracture
  • Pathognomonic for ACL tear but rare

Differential Diagnosis

Knee diagnoses

Acute Injury

• Knee fractures
• Patella fracture
• Tibial plateau fracture
• Knee dislocation
• Patella dislocation
• Segond fracture
• Meniscus and ligament knee injuries
• Patellar Tendinitis (Jumper's knee)
• Patellar tendon rupture
• Quadriceps tendon rupture

Nontraumatic/Subacute

• Septic Joint
• Gout
• Popliteal cyst (Baker's)
• Prepatellar bursitis (nonseptic)
• Septic bursitis
• Pes anserine bursitis
• Patellofemoral syndrome (Runner's Knee)
• Patellar Tendinitis (Jumper's knee)
• Osgood-Schlatter disease
• Arthritis

Evaluation

Segond Avulsion Fracture

• Plain film

Management

• Knee immobilization
• Orthopedics follow up

See Also

• Meniscus and ligament knee injuries

References

Authors

Kian Preston-Suni, Ross Donaldson, Daniel Ostermayer, Neil Young