Lateral tibial rim (Segond) fractures: MR imaging characteristics.

Abstract

The magnetic resonance (MR) imaging characteristics of lateral tibial rim (Segond) fractures and their associated injuries were reviewed in 12 patients with radiographic evidence of this fracture. Bone marrow adjacent to the fracture emitted a focally abnormal MR signal, which indicated an injury of the lateral capsular junction. The Segond fragment, however, was seen on MR images in only four of 12 patients. Associated ligamentous and meniscal injuries identified with MR imaging and arthroscopy involved the anterior (n = 11) and medial (n = 7) cruciate ligaments and the lateral (n = 4) and medial (n = 1) menisci. Focal bone marrow edema was due to injury of the lateral capsular junction. MR imaging evidence of such edema should indicate the presence of a lateral capsular injury and fracture, if one has not already been demonstrated with conventional radiography. A high association of Segond fractures with tears of the anterior cruciate ligament was confirmed, and MR imaging signs of a Segond fracture may therefore be used as indirect evidence for tears of that ligament.

Segond Fracture Revealed by Ultrasonography

“…Complete disruption of the ACL and medial and lateral meniscal tears often accompany the Segond fracture. [2][3][4] Other lesions, such as popliteus tendon tears 7 and tears of the tibial collateral ligament, 4,7 can also be involved. Associated ligamentous and meniscal injuries identified with MR imaging involve the ACL in 92% to 94% of cases, the lateral meniscus in 23% to 33% of cases, and the medial meniscus in 8% to 30% of cases.…”

“…Associated ligamentous and meniscal injuries identified with MR imaging involve the ACL in 92% to 94% of cases, the lateral meniscus in 23% to 33% of cases, and the medial meniscus in 8% to 30% of cases. 4,7 Abnormal signal intensity changes (ie, low signal on T1-weighted images and high signal on T2-weighted images) suggesting bone marrow contusion are a frequent MR finding (82%-100% of cases). 4,7 They are confined to the lateral tibial rim at the site of the avulsed cortical fragment 4,7 or they extend posteriorly, 4 to the posterior tibial plateau; however, most of them reflect a pattern of injury that is consistent with an impaction fracture of the lateral tibial plateau and femoral condyle and, therefore, complete disruption of the ACL.…”

“…The Segond fracture was previously thought to result from an avulsion fracture at the insertion of the middle portion of the lateral joint capsule, also called the LCL, of the knee. [1][2][3][4][5][6] In this regard, Weber and colleagues collateral ligament in an oblique fashion to insert at the midportion of the lateral tibia, posterior to the LCL; and fourth, an attachment of these structures connected to each other at the typical site of the Segond fracture (ie, the lateral tibial rim). These authors suggested that, in addition to the LCL, fibers of the iliotibial tract and the AOB are important factors in the pathogenesis of the Segond fracture.…”

Posterolateral and Posteromedial Corner Injuries of the Knee

“…10). 10,12,14,74,75 The midthird lateral capsular ligament is a thickening of the lateral joint capsule that attaches to the lateral femoral condyle and lateral tibia with capsular attachments to the lateral meniscus. It is the lateral equivalent of the deep medial collateral ligament.…”

Mri Evaluation of Internal Derangement of Knee

“…3,15 Segond fracture and avulsion fracture of the lateral tibial condyle at the insertion of the LCL is associated with ACL tears. 3,16,17,18,19 Tibial spine avulsions are uncommon, but specific for ACL injury. 3,18 Anterolateral tibial condyle and posterolateral femoral condyle bone contusions are seen in patients with history of forced posterior displacement of the tibia in a flexed knee.…”