Segond fracture

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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])
    • Place a fist under the proximal third of the calf
    • Apply moderate force to the anterior quadriceps
    • Heel should raise off table if ACL is intact
  • 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

Authors:

Ross Donaldson