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Segond Thoughts: A Clue to Something Bigger
A 25-year-old male presents with right knee pain after a non-contact pivoting injury during a soccer game; he reports hearing a pop.
Segond Thoughts: A Clue to Something Bigger
Author: Karishma Dhanani, DO
Peer-Reviewer and Final Editor: Alex Tomesch, MD, CAQ-SM
A 25-year-old male presents with right knee pain after a non-contact pivoting injury during a soccer game; he reports hearing a pop.
Image 1: AP x-ray of the knee. Case courtesy of Maulik S Patel, Radiopaedia.org, rID: 9758
What is the diagnosis?
Segond Fracture
- Pearl: Segond fractures are lateral proximal tibial avulsion fractures that are most commonly associated with ACL tears and meniscus injuries [1]. The origin of the Segond fracture is still debated. It’s thought to be an avulsion of the lateral capsular ligament, anterolateral ligament, and the iliotibial band are all thought to contribute to the formation of the Segond fracture [2].
Image 2: AP x-ray of the knee with annotation of segond fracture (red circle). Case courtesy of Maulik S Patel, Radiopaedia.org, rID: 9758. Annotation by author.
Which imaging modalities can be used?
Segond fractures can be seen on plain radiographs, however due to high rates of concomitant injuries, MRI are also obtained to evaluate for other injuries such as ACL tears. Additionally, MRI can also note subtle Segond fractures that are not apparent or obvious on plain radiographs [3].
Image 3: Coronal Bone window of the MRI showing a subtle lateral tibial plateau fracture (Segond Fracture) Case courtesy of Ahmed Abdrabou Radiopaedia.org, rID: 49527
References
[1] Davis, D. S., & Post, W. R. (1997). Segond fracture: lateral capsular ligament avulsion. Journal of Orthopaedic & Sports Physical Therapy, 25(2), 103-106.
[2] Phua SKA, Lim JY, Li T, Ho SWL. The segond fracture: A narrative review of the anatomy, biomechanics and clinical implications. J Clin Orthop Trauma. 2023;38:102127. Published 2023 Feb 13. doi:10.1016/j.jcot.2023.102127
[3] Kerr HD. Segond fracture, hemarthrosis, and anterior cruciate ligament disruption. J Emerg Med. 1990;8(1):29-33. doi:10.1016/0736-4679(90)90383-7
[4] Arneja SS, Furey MJ, Alvarez CM, Reilly CW. Segond fractures: not necessarily pathognemonic of anterior cruciate ligament injury in the pediatric population. Sports Health. 2010;2(5):437-439. doi:10.1177/1941738110379215
[5] Knutson T, Bothwell J, Durbin R. Evaluation and Management of Traumatic Knee Injuries in the Emergency Department. EMERGENCY MEDICINE CLINICS OF NORTH AMERICA. 2015;33(2):345-+. doi:10.1016/j.emc.2014.12.007
[6] Gaunder CL, Bastrom T, Pennock AT. Segond Fractures Are Not a Risk Factor for Anterior Cruciate Ligament Reconstruction Failure. The American Journal of Sports Medicine. 2017;45(14):3210-3215. doi:10.1177/0363546517726962
[7] Melugin HP, Johnson NR, Wu IT, Levy BA, Stuart MJ, Krych AJ. Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction?. Am J Sports Med. 2018;46(4):832-838. doi:10.1177/0363546517745280
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