Elsevier

Injury

Volume 35, Issue 9, September 2004, Pages 945-947
Injury

CASE REPORT
A tibial plateau fracture in a knee dislocation: a subtle sign of major ligamentous disruption

https://doi.org/10.1016/j.injury.2004.01.013Get rights and content

Introduction

Traumatic knee dislocation is an uncommon yet potentially devastating injury to the lower limb. Vascular disruption of the popiteal artery may occur in up to one in three knee dislocations.8 A knee dislocation that has spontaneously reduced may not be immediately evident to the clinician and the diagnosis can be over looked. Limb viability may be threatened if delay in diagnosis occurs and the possibility of vascular injury is discounted.6 This is a report of a knee dislocation in which a subtle marginal fracture of the anteromedial tibial plateau was noted on X-ray. This apparent avulsion fracture was associated with a rupture of the ACL, an intrasubstance tear of the posterior cruciate ligament (PCL) and grade III disruption of the lateral ligaments of the knee. This fracture has not been previously described in association with a knee dislocation. Recognition of this fracture is important as it can be associated with major ligamentous disruption of the knee and possible dislocation. A review of the literature of marginal fractures of the tibial plateau is included.

Section snippets

Case report

A 31-year-old man sustained a low velocity injury to his right knee after being tackled while playing soccer. He felt a ‘snap’ within his knee joint and described a sensation of his femur dissociating from his tibia. He reported sudden onset of pain and swelling in his knee and calf. He was unable to weight bear and was taken to the local accident and emergency department. Clinical examination revealed an acute haemarthrosis and an anteroposterior radiograph of the knee showed a bone fragment

Discussion

Plain radiographs of the knee can provide subtle but important clues to serious ligamentous and tendinous injuries of the knee.3 The Segond fracture is a bony avulsion of the lateral tibial plateau at the insertion of the lateral capsular ligament. Recent evidence from anatomic and magnetic resonance imaging suggests that fibres from the iliotibial tract and anterior oblique band of the fibular collateral ligament play an important role in the pathogenesis of this fracture.1 It was originally

First page preview

First page preview
Click to open first page preview

References (10)

  • J.C. Campos et al.

    Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion

    Radiology

    (2001)
  • A.P. Cohen et al.

    Impingement fracture of the anteromedial tibial margin: a radiographic sign of combined posterolateral complex and posterior cruciate ligament disruption

    Skeletal Radiol.

    (2001)
  • P.B. Delzell et al.

    Subtle fractures about the knee: innocuous-appearing yet indicative of internal derangement

    AJR Am. J. Roentgenol.

    (1996)
  • E.M. Escobedo et al.

    The ‘Reverse Segond’ fracture: association with a tear of the posterior cruciate ligament and medial meniscus

    AJR

    (2002)
  • A.B. Goldman et al.

    The segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage

    AJR

    (1988)
There are more references available in the full text version of this article.

Cited by (13)

  • Classification of tibia plateau fracture according to the “four-column and nine-segment”

    2018, Injury
    Citation Excerpt :

    Injury types 1–3 were good assists for analysis and reduction of TPF, while pretty uncommon type 4 (1/704, 0.1%) was a severe traumatic marker for neurovascular injury and compartment syndrome [50]. Two extending types covered the injury information about LCL (PLC) which played a vital role in hyperextension TPF [60–62]. 1.6% (11/704) of EX2 fibular column (avulsion of lateral femoral condyle) also required appropriate treatment.

  • Reverse Segond fracture and associated knee injuries: A case report and review of 13 published cases

    2016, Acta Orthopaedica et Traumatologica Turcica
    Citation Excerpt :

    Hall and Hochman assumed the reverse Segond fracture as a radiographic clue for a specific injury complex of the knee joint and they proposed that Reverse Segond fracture is associated with PCL rupture and medial meniscal tear.3 However, a wide variety of injuries has been detected in the published cases up to date.1,4–12 In contrast to its original description PCL rupture and medial meniscal tear is not always an essential component of this injury complex.

  • The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament

    2012, Diagnostic and Interventional Imaging
    Citation Excerpt :

    This fracture is pathognomonic of a torn anterior cruciate ligament [53]. Many studies have shown that a Segond fracture is associated with tearing the ACL in 75 to 100% of cases [54,55]. In MRI, the bone fragment is not always visible (one case in three), hence the importance of the standard A-P X-ray.

  • Fractures Associated with Knee Ligamentous Injury

    2019, Complex Knee Ligament Injuries: from Diagnosis to Management
View all citing articles on Scopus
View full text