Skip to main content
SpringerLink
Log in
Book cover

Complex Knee Ligament Injuries pp 149–159Cite as

Fractures Associated with Knee Ligamentous Injury

  • Chapter
  • First Online:

  • 1196 Accesses

Abstract

Multiligamentous injuries of the knee are often associated with coincident bony fractures due to the high energy involved. The mechanism of injury and the position of the knee at the time of the impact typically determine the type of fracture. A number of common fracture-dislocation patterns have been described. In the treatment of these complex injuries, particular attention should be paid to the timing of operative intervention, surgical rationale, and order of treatment. Three broad categories of fractures are discussed in relation to knee dislocations: avulsion and impaction fractures commonly related to multiligamentous injury, articular or periarticular fractures and resultant soft tissue injuries, and fractures remote to knee dislocations.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Becker EH, Watson JD, Dreese JC. Investigation of multiligamentous knee injury patterns with associated injuries presenting at a level I trauma center. J Orthop Trauma. 2013;27(4):226–31.

    Article  Google Scholar 

  2. Shepherd L, Abdollahi K, Lee J, Vangsness CT Jr. The prevalence of soft tissue injuries in nonoperative tibial plateau fractures as determined by magnetic resonance imaging. J Orthop Trauma. 2002;16(9):628–31.

    Article  Google Scholar 

  3. Gardner MJ, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma. 2005;19(2):79–84.

    Article  Google Scholar 

  4. Stannard JP, Lopez R, Volgas D. Soft tissue injury of the knee after tibial plateau fractur. J Knee Surg. 2010;23(4):187–92.

    Article  Google Scholar 

  5. Moore TM, Patzakis MJ, Harvey JP Jr. Ipsilateral diaphyseal femur fractures and knee ligament injuries. Clin Orthop Relat Res. 1988;232(232):182–9.

    Google Scholar 

  6. Schenck RC Jr. The dislocated knee. Instr Course Lect. 1994;43:127–36.

    PubMed  Google Scholar 

  7. Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma. 1997;11(7):525–9.

    Article  CAS  Google Scholar 

  8. Segond P. Reserches cliniques et experimentes sur les epanchements sanguins du genou par entorse. Prog Med. 1879. p. 297–419.

    Google Scholar 

  9. Albers M, et al. The iliotibial band and anterolateral capsule have a combined attachment to the Segond fracture. Knee Surg Sports Traumatol Arthrosc. 2018;26(5):1305–10.

    Article  Google Scholar 

  10. Shaikh H, et al. The segond fracture is an avulsion of the anterolateral complex. Am J Sports Med. 2017;45(10):2247–52.

    Article  Google Scholar 

  11. Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. 1988;151(6):1133–7.

    Google Scholar 

  12. Dietz GW, Wilcox DM, Montgomery JB. Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology. 1986;159(2):467–9.

    Article  CAS  Google Scholar 

  13. Wharton R, Henckel J, Bhattee G, Ball S, Church S. Segond fracture in an adult is not pathognomonic for ACL injury. Knee Surg Sports Traumatol Arthrosc. 2014;23(7):1925–8.

    Article  Google Scholar 

  14. Escobedo E, Mills WJ, Hunter JC. The ‘reverse Segond’ fracture: association with a tear of the posterior cruciate ligament and medial meniscus. AJR Am J Roentgenol. 2002;178(4):979–83.

    Article  Google Scholar 

  15. Hall FM, Hochman MG. Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skelet Radiol. 1997;26(9):553–5.

    Article  CAS  Google Scholar 

  16. Merritt AL, Wahl C. Initial assessment of the acute and chronic multiple-ligament injured (dislocated) knee. Sports Med Arthrosc Rev. 2011;19(2):93–103. https://doi.org/10.1097/JSA.0b013e3182191a7e.

    Article  Google Scholar 

  17. Sharma H, Singh GK, Gupta M, Moss M. Type IIIB tibial intercondylar eminence fracture associated with a complex knee dislocation in a grossly obese adult. Knee Surg Sports Traumatol Arthrosc. 2005;13(4):313–6.

    Article  CAS  Google Scholar 

  18. Meyers MH, FM MK. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am. 1959;41-A(2):209–20. discussion 220-2

    Article  Google Scholar 

  19. Anderson CN, Anderson AF. Tibial eminence fractures. Clin Sports Med. 2011;30(4):727–42.

    Article  Google Scholar 

  20. Dhillon MS, Singh HP, Nagi ON. Posterior cruciate ligament avulsion from the tibia : fixation by a posteromedial approach. Acta Orthop Belg. 2003;69(2):162–7.

    CAS  PubMed  Google Scholar 

  21. Horas UM, Meissner SA, Heiss C, Schnettler R. Arthroscopic fixation of posterior cruciate ligament avulsion fractures: a new minimally invasive technique. Knee Surg Sports Traumatol Arthrosc. 2015;18(6):781–3.

    Article  Google Scholar 

  22. Archbold HA, Sloan S, Nicholas R. A tibial plateau fracture in a knee dislocation: a subtle sign of major ligamentous disruption. Injury. 2004;35(9):945–7.

    Article  CAS  Google Scholar 

  23. Englesohn E, Umans H, Difelice GS. Maringal fractures of the medial tibial plateau: possible association with meniscal root tear. Skelet Radiol. 2007;36(1):73–6.

    Article  Google Scholar 

  24. Cohen AP, King D, Gibbon AJ. Impingement fracture of the anteromedial tibial margin: a radiographic sign of combined posterolateral complex and posterior cruciate ligament disruption. Skelet Radiol. 2001;30(2):114–6.

    Article  CAS  Google Scholar 

  25. Garth WP Jr, Wilson T. Open reduction of a lateral femoral notch associated with an acute anterior cruciate ligament tear. Arthroscopy. 2001;17(8):874–7.

    Article  Google Scholar 

  26. Sadlo PA, Nebelung W. Arthroscopically assisted reduction of a lateral femoral noch in acute tear of the anterior cruciate ligament. Arthroscopy. 2006;22(5):574e1–3.

    Article  Google Scholar 

  27. 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. 2002;180(2):381–7.

    Article  Google Scholar 

  28. Shindell R, Walsh WM, Connolly JF. Avulsion fracture of the fibula: the “arcuate sign” of posterolateral knee instability. Nebr Med J. 1984;69(11):369–71.

    CAS  PubMed  Google Scholar 

  29. Nakhostine M, Perko M, Cross M. Isolated avulsion of the popliteus tendon. J Bone Joint Surg Br. 1995;77(2):242–4.

    Article  CAS  Google Scholar 

  30. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy. 2003;19(7):717–21.

    Article  Google Scholar 

  31. Sillanpaa PJ, Salonen E, Pihlajamaki H, Maenpaa HM. Medial patellofemoral ligament avulsion injury at the patella: classi cation and clinical outcome. Knee Surg Sports Traumatol Arthrosc. 2013;22:2414–8.

    Article  Google Scholar 

  32. Brophy RH, et al. Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment. Arthroscopy. 2010;26(1):112–20.

    Article  Google Scholar 

  33. Kuhle J, et al. Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. Int Orthop. 2013;37(12):2385–94.

    Article  Google Scholar 

  34. Siliski JM, Mahring M, Hofer HP. Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation. J Bone Joint Surg Am. 1989;71(1):95–104.

    Article  CAS  Google Scholar 

  35. Schenck RC Jr, McGanity PL, Heckman JD. Femoral-sided fracture-dislocation. J Orthop Trauma. 1997;11(6):416–21.

    Article  Google Scholar 

  36. Shetty GM, et al. Incarcerated patellar tendon in Hoffa fracture: an unusual cause of irreducible knee dislocation. Knee Surg Sports Traumatol Arthrosc. 2008;16(4):378–81.

    Article  Google Scholar 

  37. Kosanovic M, Komadina R, Batista M. Patella fractures associated with injuries of the knee ligament. Arch Orthop Trauma Surg. 1998;117(1-2):108–9.

    Article  CAS  Google Scholar 

  38. Liow RY, et al. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br. 2003;85(6):845–51.

    Article  CAS  Google Scholar 

  39. Szalay MJ, Hosking OR, Annear P. Injury of knee ligament associated with ipsilateral femoral shaft fractures and with ipsilateral femoral and tibial shaft fractures. Injury. 1990;21(6):398–400.

    Article  CAS  Google Scholar 

  40. Chahal J, et al. PCL reconstruction with the tibial inlay technique following intra-medullary nail fixation of an ipsilateral tibial shaft fracture: a treatment algorithm. Knee Surg Sports Traumatol Arthrosc. 2010;18(6):777–80.

    Article  Google Scholar 

  41. Boisrenoult P, et al. Vascular lesions associated with bicruciate and knee dislocation ligamentous injury. Orthop Traumatol Surg Res. 2009;95(8):621–6.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. OrthoSport Victoria, Epworth Healthcare, Richmond, VIC, Australia

    Ciaran Thrush, Timorthy S. Whitehead, Jérôme Murgier & Brian M. Devitt

Authors
  1. Ciaran Thrush
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timorthy S. Whitehead
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jérôme Murgier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian M. Devitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian M. Devitt .

Editor information

Editors and Affiliations

  1. Orthopaedics and Traumatology, University of Rome “Foro Italico”, Rome, Italy

    Fabrizio Margheritini

  2. Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal

    João Espregueira-Mendes

  3. O.A.S.I. Bioresearch Foundation NPO, Milan, Italy

    Alberto Gobbi

Rights and permissions

Reprints and permissions

Copyright information

© 2019 ISAKOS

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Thrush, C., Whitehead, T.S., Murgier, J., Devitt, B.M. (2019). Fractures Associated with Knee Ligamentous Injury. In: Margheritini, F., Espregueira-Mendes, J., Gobbi, A. (eds) Complex Knee Ligament Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58245-9_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-58245-9_13

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-58244-2

  • Online ISBN: 978-3-662-58245-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation