Segond Fracture: Causes, Symptoms & Treatment
The Segond fracture is a small avulsion fracture of the lateral tibial plateau and is considered a reliable indicator of an anterior cruciate ligament injury.
Things worth knowing about "Segond fracture"
The Segond fracture is a small avulsion fracture of the lateral tibial plateau and is considered a reliable indicator of an anterior cruciate ligament injury.
What Is a Segond Fracture?
A Segond fracture is a specific type of avulsion fracture in which a small fragment of bone is torn away from the lateral (outer) edge of the tibial plateau (the top surface of the shinbone). It occurs when excessive tension is placed on the lateral capsular ligaments of the knee, pulling off a piece of bone at their attachment site. The injury was first described by French surgeon Paul Segond in 1879.
Although the fracture itself is small and may appear subtle on imaging, it carries significant clinical importance: it is considered a pathognomonic sign – meaning a near-certain indicator – of a concurrent anterior cruciate ligament (ACL) tear. The ACL is involved in more than 75 % of cases.
Causes and Mechanism of Injury
The Segond fracture results from a specific loading pattern at the knee:
- Internal rotation of the tibia combined with knee flexion and valgus stress
- Commonly caused by sports injuries, particularly in football, skiing, basketball, and American football
- Twisting falls or direct force applied to the inner side of the knee
The combined rotational and valgus forces overstress the lateral capsular structures, resulting in an avulsion fracture at the lateral tibial margin.
Associated Injuries
A Segond fracture is rarely an isolated finding. The following structures are commonly injured at the same time:
- Anterior cruciate ligament (ACL): in 75–100 % of cases
- Medial or lateral meniscus: in approximately 66 % of cases
- Posterior cruciate ligament: less commonly affected
- Collateral ligaments and other capsular structures
Because of these frequent associated injuries, the identification of a Segond fracture on imaging should prompt a thorough evaluation for complex knee ligament damage.
Symptoms
Typical symptoms following a Segond fracture include:
- Acute pain at the lateral (outer) aspect of the knee
- Swelling, bruising, and often a hemarthrosis (blood accumulation within the knee joint)
- Feeling of instability or giving way, especially during rotational movements
- Limited range of motion and pain with weight-bearing
Diagnosis
Diagnosis of a Segond fracture involves several steps:
Physical Examination
The physician assesses knee stability using specific tests such as the Lachman test or the anterior drawer test to evaluate ACL integrity and overall joint stability.
X-Ray Imaging
On an anteroposterior (AP) radiograph of the knee, the Segond fracture appears as a small, oval or elliptical bony fragment at the lateral edge of the tibial plateau. This characteristic finding often allows an initial diagnosis to be made from plain X-rays alone.
MRI (Magnetic Resonance Imaging)
MRI is the most important imaging modality for fully evaluating all associated soft tissue injuries, including damage to the cruciate ligaments, menisci, and cartilage. It provides detailed information about the full extent of the knee injury.
Treatment
Treatment of a Segond fracture is primarily guided by the associated injuries, as the fracture itself rarely requires direct surgical fixation.
Conservative Treatment
In stable cases without significant associated injuries, the knee may be managed conservatively:
- Rest and protected weight-bearing
- Ice application and elevation to reduce swelling
- Physiotherapy to restore strength and stability
- Knee brace for additional support during healing
Surgical Treatment
When a concurrent ACL rupture or severe meniscal tear is present, surgery is usually required:
- ACL reconstruction (arthroscopic, commonly using autograft tendon)
- Meniscal repair or partial meniscectomy in cases of meniscal tears
- Repair of additional ligament injuries as indicated by clinical findings
Prognosis and Rehabilitation
The prognosis after a Segond fracture largely depends on the severity of associated injuries. Following ACL reconstruction, rehabilitation typically takes 6 to 12 months before a full return to sports activity is possible. Consistent physiotherapy is essential for achieving a good long-term outcome and reducing the risk of chronic knee instability or early-onset osteoarthritis.
References
- Segond P. - Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Progrès Médical, 1879.
- Dietz GW et al. - Significance of the Segond fracture in the diagnosis of anterior cruciate ligament tears. AJR American Journal of Roentgenology, 1986; 146(6): 1166–1168.
- Herbst E et al. - Lateral Extra-articular Structures and the Anterolateral Ligament. American Journal of Sports Medicine, 2017; 45(9): 2142–2153.
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