Segond Fracture

A segond fracture is an avulsion fracture located in the lateral aspect of the tibial plateau of the knee.⁶

Segond Fracture: Pearls

It is frequently a varus stress that leads to a lateral collateral complex injury. Contusions and bone injuries are common . A capsular injury on either the medial or lateral side may exist in conjunction with a flake fracture near the joint surface, and this is referred to as the Segond or pseudo-Segond fracture. A juxta-articular Segond or pseudo-Segond fracture is indicative of a capsular injury.⁸On x-ray, this is known as the lateral capsular sign.

Segond Fracture: Clinical Presentation

Segond fractures typically arise from internal rotation and varus stress.⁴

Segond Fracture: Pathology

Segond fractures arise from avulsion of the middle third of the lateral capsular ligaments.⁹

Segond Fracture: MRI

Necessary for identification of internal derangement.³

Segond Fracture: Differential Diagnosis

Arcuate sign: avulsion fracture of the head of the fibula.⁴Attachment to the head / styloid includes arcuate and fabellofibular ligament.

Segond Fracture: Treatment

To assist anterior rotational instability, surgery is usually required.²

Segond Fracture: Example

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This 26-year-old male presents with right knee pain post ATV accident.

Image 1 - Coronal T2 FS Image 2 - Axial T2

FINDINGS:

Moderate effusion. Complex signal within the effusion for which coagulated hemorrhage is favored.

ACL is intact, an intercondylar spine avulsion which is slightly distracted is present. This correlates with the CT. Fragmentation of the intercondylar spine is present. Osseous margins are better visualized on the CT.

MCL demonstrates interstitial tear. This is high-grade and complete or near complete. Contusions involve the sulcus terminalis of the lateral femoral condyle, posterolateral tibia, and medial femoral condyle. Fibular collateral ligament sprain is present. Diffuse soft tissue swelling is present.

Lateral meniscus is intact. Medial meniscus demonstrates an undersurface vertical tear involving the outer third of the posterior horn and body. Tear propagates as a radial free edge tear into the root.

Flake-like Segond fracture is also demonstrated on the MRI as well as the CT. Region of contusions involves the subjacent lateral tibia. Mid third lateral capsular ligament is still attached to the flake-like Segond fracture.

Popliteus tendon is intact. No conjoined tendon avulsion is demonstrated.

Segond Fracture: Appendix

Associations

ACL tear:

Most common associated injury³
75-100% of cases¹

Medial or lateral meniscal tear:

Posterior horn most common³
66-75% of cases¹

Avulsion of:

ACL from the tibial attachment: rare³
Fibular attachment of the long head of biceps femoris³
Fibular collateral ligament³

SF: References

Campos JC, Chung CB, Lektrakul N et-al. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology. 2001;219 (2): 381-6.
Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol. 1988;151 (6): 1163-7.
Gottsegen CJ, Eyer BA, White EA et-al. Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics. 2008;28 (6): 1755-70.
Huang GS, Yu JS, Munshi M et-al. Avulsion fracture of the head of the fibula (the "arcuate" sign): MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament. AJR Am J Roentgenol. 2003;180 (2): 381-7.
Murphy A, Gaillard, F, et-al. Segond Fracture: Radiopaedia (sourced 10Jan2018): https://radiopaedia.org/articles/segond-fracture
Paul Ferdinand Segond from whonamedit.com, the dictionary of medical eponyms.
Pomeranz SJ. Gamuts & Pearls in MRI & Orthopedics. Ohio, The Merten Company, 1997.
Roberts CC, Towers JD, Spangehl MJ et-al. Advanced MR imaging of the cruciate ligaments. Radiol. Clin. North Am. 2007;45 (6): 1003-16, vi-vii.