Adolescent Segond Fracture With an Intact Anterior Cruciate Ligament

Full article available online at Healio.com/Orthopedics. Search: 20120621-33 Segond fractures, or avulsion fractures of the proximal lateral tibial plateau, have been well documented and studied since their original description in 1878. Segond fractures have a widely recognized pathognomonic association with anterior cruciate ligament (ACL) injuries and often prompt orthopedic surgeons to consider reconstruction following radiographic and clinical evaluation. Adolescent patients are particularly vulnerable to these fractures due to the relative weakness of their physeal growth plates compared with the strength of their accompanying ligamentous structures. This article describes a case of a 13-year-old boy who sustained a Segond fracture that was not coupled with an ACL avulsion or tear. The patient sustained a twisting injury to his knee. He presented to the emergency room with an effusion and radiographic findings consistent with a Segond fracture. On follow-up examination 1 week after injury, the ACL was intact. The patient was followed for 5 months of conservative treatment. At final follow-up, the patient had reestablished his previous level of activity. This article describes the history, physical examination, and radiographic findings necessary to care for patients who present with a Segond fracture. Although considered pathognomonic for an associated ACL injury, this article describes a Segond fracture that occurred in isolation. Drs Reddy, Alexander, Hussain, and Leland are from the Department of Orthopaedics, University of Chicago Medical Center, Chicago, Illinois. Drs Reddy, Alexander, and Hussain have no relevant financial relationships to disclose. Dr Leland is a paid consultant and expert witness for Stryker. Correspondence should be addressed to: Deepak Reddy, MD, Department of Orthopaedics, University of Chicago Medical Center, 5841 S Maryland Ave, MC 3079, Chicago, IL 60637 (deepak. reddy@uchospitals.edu). doi: 10.3928/01477447-20120621-33 Adolescent Segond Fracture With an Intact Anterior Cruciate Ligament Deepak ReDDy, MD; ReginalD alexanDeR, MD; Waqas M. Hussain, MD; J. MaRtin lelanD, MD e1112 Figure: Sagittal proton-density–weighted fast spin echo magnetic resonance image using a 1.5 Telsa magnet through the intercondylar notch of the left knee showing an intact anterior cruciate ligament (arrow) with preserved tibial and femoral insertions. No signal change occurred in the substance of the anterior cruciate ligament.