Segond Fracture

Plain radiographs provide many indications suggestive of acute ACL rupture avulsion fracture of the lateral tibial plateau, or Segond fracture, which is in fact an injury to the lateral joint capsule, avulsion of the Gerdy s tubercle and a lateral notch lesion, which is a compression fracture of the lateral femoral condyle of more than 2 mm seen on lateral radiograph. A tibial rim lesion on the posterolateral lip of the lateral tibial plateau can also be found alone or associated with the lateral notch lesion and is termed a kissing contusion. Joint effusions can also be detected on simple radiographs (Fig. 20.6). 

Goldman AB, Pavlov H, Rubenstein D (1988) The Segond fracture of the proximal tibia a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol 151 (6) 1163-1167. doi 10.2214/ajr.l51.6.1163... 

Radiographs can identify associated avulsion injuries, such as Pelegrini-Stieda lesions (avulsion of the medial femoral condyle at the origin of the medial collateral ligament) and Segond lesion (avulsion fracture of the lateral tihial plateau). Segond fractures are associated with LCL, ACL and meniscal tears (Sferopoulos et al. 2006). 

Associated signs of ACL injury are common in children and include lipohaemarthrosis (this may indicate bony injury and a tibial avulsion injury should be exduded), contusion in the lateral femoral condyle and posterior tihial plateau, depression within the lateral condylopatellar sulcus (secondary to impaction of the lateral condyle on the tihial plateau) and Segond fractures (Prince et al. 2005). 

Furthermore, ACL tears are often associated with injuries to additional structures, such as the medial collateral ligament, meniscal tears, and Segond fracmres, which are capsular avulsion fractures of the lateral tibial plateau, found in 6-13 % of ACL ruptures [27] (Fig. 12.4C). 

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