Segond fracture
(Redirected from Segond Fracture)
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
- 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
- Knee dislocation
- Knee fractures
- Meniscus and ligament knee injuries
- Patella dislocation
- Patellar tendonitis
- Patellar tendon rupture
- Quadriceps tendon rupture
Nontraumatic/Subacute
- Arthritis
- Gout and Pseudogout
- Osgood-Schlatter disease
- Patellofemoral syndrome (Runner's Knee)
- Patellar tendonitis (Jumper's knee)
- Pes anserine bursitis
- Popliteal cyst (Bakers cyst)
- Prepatellar bursitis (nonseptic)
- Septic bursitis
- Septic joint
- DVT
Evaluation
- Plain film
Management
- Knee immobilization
- Orthopedics follow up
Disposition
- Outpatient management
See Also
References
- ↑ 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.
- ↑ 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
- ↑ 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