SURGICAL TREATMENT OF Segond FRACTURE AND COMPLICATIONS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Bo ¹ , RAN Xia ² , ZHANG Minghua ¹ , HE Chao ¹ , JIANG Dianming ³

1Department of Orthopedics, 2Department of Nephrology, Yongchuan Hospital, Chongqing Medical University, Yongchuan Chongqing, 402160, P.R.China;;
3Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University. Corresponding author: ZHANG Minghua, E-mail: zhangminghua023@126.com;

Corresponding author：

Keywords：

Segond fracture; Anterior cruciate ligament injury; Collateral ligament injury; Meniscus injury; Arthroscopy

DOI：

10.7507/1002-1892.20130228

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Objective To investigate the injury mechanism, clinical characteristics, and treatments of Segond fracture and complications. Methods Fifteen patients suffering from Segond fracture were treated between January 2007 and December 2011. There were 10 males and 5 females, aged 16-50 years (mean, 31.8 years). Fracture was caused by traffic accident in 8 cases, by sports in 6 cases, and by bruise in 1 case. Before operation, the knee range of motion (ROM) was (36.60 ± 8.94)°; the Lysholm score was 32.27 ± 3.73; and the International Knee Documentation Committee (IKDC) score was 42.34 ± 4.97. The duration from injury to operation was 1-3 weeks with an average of 1.2 weeks. In 12 patients having associated anterior cruciate ligament (ACL) injury, arthroscopic reconstruction of ACL was performed with allogeneic anterior tibial tendon; in 2 patients having associated avulsion fracture of the intercondylar eminence of the tibia, arthroscopic fracture reduction and fixation with Orthocord wire were performed. In 8 patients having associated meniscus injury, meniscus suture and meniscectomy were performed in 3 and 5 patients, respectively. In 7 patients having associated collateral ligament injury, conservative treatment was given in 5 patients, and medial collateral ligament was repair in 2 patients. Results All incisions healed primarily without complications of infection and nerve or blood vessel injury. All the patient were followed up 12-16 months (mean, 14.3 months). At 12 months after operation, the results of anterior drawer test, Lachman test, and lateral stress test were all negative. The knee ROM was (129.27 ± 5.89)°, the IKDC score and Lysholm score were significantly increased to 89.45 ± 3.05 and 87.87 ± 4.12 at 12 months after operation; all showing significant differences when compared with preoperative values (P lt; 0.05). Conclusion Segond fracture is often combined with ACL, collateral ligament, and meniscus injuries, and the evidence of Segond fracture can bly suggests the knee injury. Personalized treatment should be chosen according to complications.

Citation： ZHAO Bo,RAN Xia,ZHANG Minghua,HE Chao,JIANG Dianming. SURGICAL TREATMENT OF Segond FRACTURE AND COMPLICATIONS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(9): 1045-1049. doi: 10.7507/1002-1892.20130228 Copy

1.	Dietz GW, Wilcox DM, Montgomery JB. Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology, 1986, 159(2): 467-469.
2.	Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol, 1988, 151(6): 1163-1167.
3.	Abdalla FH, Tehranzadeh J, Horton JA. Avulsion of lateral tibial condyle in skiing. Am J Sports Med, 1982, 10(6): 368-370.
4.	Campos JC, Chung CB, Lektrakul N, et al. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology, 2001, 219(2): 381-386.
5.	Hess T, Rupp S, Hopf T, et al. Lateral tibial avulsion fractures and disruptions to the anterior cruciate ligament. A clinical study of their incidence and correlation. Clin Orthop Relat Res, 1994, (303): 193-197.
6.	王琪, 刘宪民, 刘松波, 等. Segond骨折合并前交叉韧带损伤的外科治疗. 中华创伤杂志, 2012, 28(8): 726-729.
7.	黄建明, 沈锋, 眭杰, 等. Segond骨折的临床特点与治疗策略. 中国骨与关节损伤杂志, 2011, 26(6): 509-511.
8.	Peltola EK, Mustonen AO, Lindahl J, et al. Segond fracture combined with tibial plateau fracture. AJR Am J Roentgenol, 2011, 197(6): W1101-1104.
9.	Sferopoulos NK, Rafailidis D, Traios S, et al. Avulsion fractures of the lateral tibial condyle in children. Injury, 2006, 37(1): 57-60.
10.	Arneja SS, Furey MJ, Alvarez CM, et al. Segond fractures: not necessarily pathognemonic of anterior cruciate ligament injury in the pediatric population. Sports Health, 2010, 2(5): 437-439.
11.	DeLee JC, Curtis R. Anterior cruciate ligament insufficiency in children. Clin Orthop Relat Res, 1983, (172): 112-118.
12.	Pieter AM. Tibial plateau and spine fractures//McGinty JB. Operative Arthroscopy. 2nd ed. Philadelphia: Lippincott-Raven, 1996: 589-590.
13.	Arnoczky SP, Rubin RM, Marshall JL. Microvasculature of the cruciate ligaments and its response to injury. An experimental study in dogs. J Bone Joint Surg (Am), 1979, 61(8): 1221-1229.
14.	Falciglia F, Mastantuoni G, Guzzanti V. Segond fracture with anterior cruciate ligament tear in an adolescent. J Orthop Traumatol, 2008, 9(3): 167-169.
15.	洪雷, 冯华, 耿向苏, 等. Segond骨折与前交叉韧带损伤相关性的临床研究. 中华外科杂志, 2007, 45(2): 94-95.
16.	Edson CJ. Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc, 2006, 14(2): 105-110.
17.	Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg (Am), 2010, 92(5): 1266-1280.
18.	Kovachevich R, Shah JP, Arens AM, et al. Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc, 2009, 17(7): 823-829.
19.	Woods GW, Stanley RF, Tullos HS. Lateral capsular sign: x-ray clue to a significant knee instability. Am J Sports Med, 1979, 7(1): 27-33.
20.	Tei K, Kubo S, Matsumoto T, et al. Combined osteochondral fracture of the posterolateral tibial plateau and Segond fracture with anterior cruciate ligament injury in a skeletally immature patient. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 252-255.

1. Dietz GW, Wilcox DM, Montgomery JB. Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology, 1986, 159(2): 467-469.
2. Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol, 1988, 151(6): 1163-1167.
3. Abdalla FH, Tehranzadeh J, Horton JA. Avulsion of lateral tibial condyle in skiing. Am J Sports Med, 1982, 10(6): 368-370.
4. Campos JC, Chung CB, Lektrakul N, et al. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology, 2001, 219(2): 381-386.
5. Hess T, Rupp S, Hopf T, et al. Lateral tibial avulsion fractures and disruptions to the anterior cruciate ligament. A clinical study of their incidence and correlation. Clin Orthop Relat Res, 1994, (303): 193-197.
6. 王琪, 刘宪民, 刘松波, 等. Segond骨折合并前交叉韧带损伤的外科治疗. 中华创伤杂志, 2012, 28(8): 726-729.
7. 黄建明, 沈锋, 眭杰, 等. Segond骨折的临床特点与治疗策略. 中国骨与关节损伤杂志, 2011, 26(6): 509-511.
8. Peltola EK, Mustonen AO, Lindahl J, et al. Segond fracture combined with tibial plateau fracture. AJR Am J Roentgenol, 2011, 197(6): W1101-1104.
9. Sferopoulos NK, Rafailidis D, Traios S, et al. Avulsion fractures of the lateral tibial condyle in children. Injury, 2006, 37(1): 57-60.
10. Arneja SS, Furey MJ, Alvarez CM, et al. Segond fractures: not necessarily pathognemonic of anterior cruciate ligament injury in the pediatric population. Sports Health, 2010, 2(5): 437-439.
11. DeLee JC, Curtis R. Anterior cruciate ligament insufficiency in children. Clin Orthop Relat Res, 1983, (172): 112-118.
12. Pieter AM. Tibial plateau and spine fractures//McGinty JB. Operative Arthroscopy. 2nd ed. Philadelphia: Lippincott-Raven, 1996: 589-590.
13. Arnoczky SP, Rubin RM, Marshall JL. Microvasculature of the cruciate ligaments and its response to injury. An experimental study in dogs. J Bone Joint Surg (Am), 1979, 61(8): 1221-1229.
14. Falciglia F, Mastantuoni G, Guzzanti V. Segond fracture with anterior cruciate ligament tear in an adolescent. J Orthop Traumatol, 2008, 9(3): 167-169.
15. 洪雷, 冯华, 耿向苏, 等. Segond骨折与前交叉韧带损伤相关性的临床研究. 中华外科杂志, 2007, 45(2): 94-95.
16. Edson CJ. Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc, 2006, 14(2): 105-110.
17. Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg (Am), 2010, 92(5): 1266-1280.
18. Kovachevich R, Shah JP, Arens AM, et al. Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc, 2009, 17(7): 823-829.
19. Woods GW, Stanley RF, Tullos HS. Lateral capsular sign: x-ray clue to a significant knee instability. Am J Sports Med, 1979, 7(1): 27-33.
20. Tei K, Kubo S, Matsumoto T, et al. Combined osteochondral fracture of the posterolateral tibial plateau and Segond fracture with anterior cruciate ligament injury in a skeletally immature patient. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 252-255.

Chinese Journal of Reparative and Reconstructive Surgery

SURGICAL TREATMENT OF Segond FRACTURE AND COMPLICATIONS

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