Abstract
The aims of this study were to assess the incidence of reverse Segond fracture, to examine the associated ligamentous injuries, and to examine how often reverse Segond fracture coexists with a knee dislocation. At a level 1 trauma center, an 11-year period of emergency department multidetector-row computed tomography (MDCT) examinations for knee trauma was evaluated for reverse Segond and Segond fractures. Surgical findings served as the reference standard for intra-articular injuries. The hospital discharge register was searched for the diagnosis of knee dislocation from August 2000 through the end of August 2011. A total of 1,553 knee MDCT examinations were evaluated. Ten patients with a reverse Segond fracture were found, comprising 0.64 % of emergency room acute knee trauma MDCT examinations. Seven patients who had a reverse Segond fracture were operated: Three had an avulsion fracture of the anterior cruciate ligament, one had an avulsion fracture of posterior cruciate ligament, two had a lateral meniscal tear, and two had a medial collateral ligament tear. The ratio of reverse Segond fractures to Segond fractures was 1:4. None of the 71 knee dislocation patients had a reverse Segond fracture. Reverse Segond fracture is a rare finding even in a level 1 trauma center. Cruciate ligament injuries appear to be associated with avulsion fracture, but every patient does not have PCL injury, as previously reported. Our results do not support the association of knee dislocation with reverse Segond fracture.
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References
Dietz GW, Wilcox DM, Montgomery JB (1986) Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology 159:467–469
Hall FM, Hochman MG (1997) Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skeletal Radiol 26:553–555
Engelsohn E, Umans H, Difelice GS (2007) Marginal fractures of the medial tibial plateau: possible association with medial meniscal root tear. Skeletal Radiol 36:73–76
Escobedo EM, Mills WJ, Hunter JC (2002) The “reverse Segond” fracture: association with a tear of the posterior cruciate ligament and medial meniscus. AJR Am J Roentgenol 178:979–983
Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res (138):94–104
Peltola EK, Mustonen AO, Lindahl J et al (2011) Segond fracture combined with tibial plateau fracture. AJR Am J Roentgenol 197:W1101–W1104
Bennett DL, George MJ, El-Khoury GY et al (2003) Anterior rim tibial plateau fractures and posterolateral corner knee injury. Emerg Radiol 10:76–83
Cohen AP, King D, Gibbon AJ (2001) Impingement fracture of the anteromedial tibial margin: a radiographic sign of combined posterolateral complex and posterior cruciate ligament disruption. Skeletal Radiol 30:114–116
Vanek J (1994) Posteromedial fracture of the tibial plateau is not an avulsion injury. A case report and experimental study. J Bone Joint Surg Br 76:290–292
Markhardt BK, Gross JM, Monu JU (2009) Schatzker classification of tibial plateau fractures: use of CT and MR imaging improves assessment. Radiographics 29:585–597
Li G, Gill TJ, DeFrate LE et al (2002) Biomechanical consequences of PCL deficiency in the knee under simulated muscle loads—an in vitro experimental study. J Orthop Res 20:887–892
Robertson A, Nutton RW, Keating JF (2006) Dislocation of the knee. J Bone Joint Surg Br 88:706–711
Gardner MJ, Yacoubian S, Geller D et al (2005) The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma 19:79–84
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The authors thank Dr. Sharon J. Kuong, M.D., for her linguistic expertise.
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Peltola, E.K., Lindahl, J. & Koskinen, S.K. The reverse Segond fracture: not associated with knee dislocation and rarely with posterior cruciate ligament tear. Emerg Radiol 21, 245–249 (2014). https://doi.org/10.1007/s10140-013-1192-y
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DOI: https://doi.org/10.1007/s10140-013-1192-y