IS Case 171: Segond fracture

Sam McCabe, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-21

History

Patient is an 27-year-old male with lateral knee pain from a wrestling injury.

There is a small vertically oriented chip fracture just below the lateral tibial plateau. MR images confirm the tibial fracture and reveal a torn ACL.

The Segond fracture, originally described by French surgeon Paul Segond in 1879, is avulsion of a small bone fragment from the lateral aspect of the proximal tibia just below the plateau. The knee joint capsule inserts at the site of fracture. The fracture is best seen on an AP or tunnel view of the knee. The mechanism of injury is varus ("bowing") stress and internal rotation of the tibia applied to a flexed knee. The importance of the Segond fracture lies in its associations with ACL tears (75-100%) and meniscal tears (medial and/or lateral meniscal tears are seen in 70%). Capsular tears, fibular head fractures, and avulsions of Gerdy's tubercle can also be seen. When a Segond fracture is seen by plain film, MR is indicated to evaluate for associated injuries.

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Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology. 2001 May;219(2):381-6. [PMID: 11323461]