Segond fracture

Segond fracture refers to an avulsion fracture occurring on the lateral aspect of the tibial plateau. This distinctive injury involves a small bone fragment being pulled away from the main tibial structure, often due to forceful twisting or hyperextension of the knee joint. The Segond fracture is closely associated with tears of the anterior cruciate ligament (ACL) and is recognized as a reliable indicator of more significant ligamentous injuries.

Segond Fracture

Anatomy and Mechanism of Injury

The Segond fracture is believed to result from excessive tension applied to the anterolateral ligament (ALL), a structure connecting the lateral femoral condyle to the anterolateral tibia. Sudden force, as in sports or trauma, can cause the ALL to exert significant pull on the lateral tibial plateau, leading to the avulsion fracture. It commonly coexists with ACL tears, with up to 75-100% of Segond fractures occurring alongside ACL injuries. Additional injuries, like medial meniscal tears, may also be present.

Segond Fracture on CT scan

Diagnosis

Clinical diagnosis of a Segond fracture involves a thorough history and physical examination, complemented by imaging studies such as X-rays. X-rays typically reveal the characteristic avulsion fracture, though small fragments may not always be visible. In such cases, computed tomography (CT) scans or magnetic resonance imaging (MRI) can provide confirmation. MRI is particularly useful for assessing associated ligamentous injuries, including ACL tears.

Treatment

Treatment of Segond fractures depends on the injury's severity and concurrent ligamentous damage. Isolated fractures without significant instability may be managed conservatively with knee immobilization, rest, ice, compression, elevation (RICE), pain management, and physical therapy. In cases of associated ACL tears or significant instability, surgical intervention is often necessary. This may involve ACL reconstruction, fixation of the avulsion fracture, and repair or reconstruction of other injured ligaments.

Segond Fracture with CT scan

Prognosis

With appropriate treatment and rehabilitation, the prognosis for Segond fractures is generally favorable. Most patients regain full knee function and can resume pre-injury activities. However, recovery may take several months, and some individuals may experience residual instability or an increased risk of future knee injuries. Adherence to rehabilitation programs is crucial to minimize risks.

Prevention

Prevention strategies for knee injuries, including Segond fractures, involve proper conditioning, strengthening exercises, balance training, use of appropriate protective gear, adherence to proper techniques, warm-up and cool-down routines, and gradual progression in physical activities.

Complications

Complications of Segond fractures include persistent knee instability, post-traumatic arthritis, stiffness, re-tear of reconstructed ligaments, and surgical complications. Prompt diagnosis, appropriate treatment, and diligent rehabilitation help mitigate these risks.

See also

• Avulsion fracture
• Anterior cruciate ligament injury
• Knee injuries

References

• The Segond Fracture: A Bony Injury of the Anterolateral Ligament of the Knee
• Segond Fractures Are Not a Risk Factor for Anterior Cruciate Ligament Reconstruction Failure
• Arthroscopic Repair of Meniscal Ramp Lesions Through a Posteromedial Portal During Anterior Cruciate Ligament Reconstruction
• Segond fracture with anterior cruciate ligament tear: a case report of an uncommon fracture

Segond fracture Resources
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