Difference between revisions of "Segond fracture"

(Text replacement - "==References== " to "==References== <references/> ")
(Management)
Line 16: Line 16:
 
*Knee immobilization
 
*Knee immobilization
 
*Orthopedics follow up
 
*Orthopedics follow up
 +
 +
==Disposition==
 +
*Outpatient management
  
 
==See Also==
 
==See Also==

Revision as of 04:20, 10 May 2019

Background

  • Avulsion fracture of proximal lateral tibia
  • Pathognomic for ACL tear

Clinical Features

ACL Injury

  • Hearing/feeling a "pop" during injury with ensuing knee instability is pathognomonic
  • Lever Sign or Lelli’s test (highest sensitivity at 94[1]-100%[2]). Demonstrated to be effective and 100% sensitive in a small ED study, especially compared to traditional methods[3].
    • Place a fist under the proximal third of the calf, opposite from tibial tuberosity
    • Apply moderate force to the anterior quadriceps
    • Heel should raise off table if there is not a complete rupture of ACL
Lever Test
  • Anterior Drawer Sign
    • Pt supine, knee flexed 90', attempt to displace tibia from femur in a forward direction
    • Displacement of >6mm compared w/ opposite knee indicates injury
  • Lachman Test
    • Pt supine, knee flexed 30', femur held w/ one hand, prox tibia pulled up w/ other hand
    • Displacement >5mm or soft end-point indicates injury
  • Pivot Shift Test
  • Segond Fracture
    • Pathognomonic for ACL tear but rare

Differential Diagnosis

Knee diagnoses

Acute knee injury

Nontraumatic/Subacute

Evaluation

Segond Avulsion Fracture
  • Plain film

Management

  • Knee immobilization
  • Orthopedics follow up

Disposition

  • Outpatient management

See Also

References

  1. Deveci A, Cankaya D, Yilmaz S, Özdemir G, Arslantaş E, Bozkurt M. The arthroscopical and radiological correlation of lever sign test for the diagnosis of anterior cruciate ligament rupture. SpringerPlus. 2015; 4:830. doi:10.1186/s40064-015-1628-9.
  2. Lelli A, Di Turi RP, Spenciner DB, et al. Knee Surg Sports Traumatol Arthrosc. 2016; 24:2794. https://doi.org/10.1007/s00167-014-3490-7
  3. Mcquivey, K. S., Christopher, Z. K., Chung, A. S., Makovicka, J., Guettler, J., & Levasseur, K. (2019). Implementing the Lever Sign in the Emergency Department: Does it Assist in Acute Anterior Cruciate Ligament Rupture Diagnosis? A Pilot Study. The Journal of Emergency Medicine, 57(6), 805–811. doi: 10.1016/j.jemermed.2019.09.003