The Segond Fracture Is an Avulsion of the Anterolateral Complex

2017 ◽  
Vol 45 (10) ◽  
pp. 2247-2252 ◽  
Author(s):  
Humza Shaikh ◽  
Elmar Herbst ◽  
Ata Amir Rahnemai-Azar ◽  
Marcio Bottene Villa Albers ◽  
Jan-Hendrik Naendrup ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Anterolateral Ligament ◽  
Fibular Head ◽  
Lateral Tibial Plateau ◽  
Segond Fracture ◽  
Posterior Aspect ◽  
Tibial Insertion ◽  
Anterolateral Capsule ◽  
The Mean

Background: The Segond fracture was classically described as an avulsion fracture of the anterolateral capsule of the knee. Recently, some authors have attributed its pathogenesis to the “anterolateral ligament” (ALL). Biomechanical studies that have attempted to reproduce this fracture in vitro have reported conflicting findings. Purpose: To determine the anatomic characteristics of the Segond fracture on plain radiographs and magnetic resonance imaging (MRI), to compare this location with the location of the ALL described in prior radiographic and anatomic publications, and to determine the fracture’s attachments to the soft tissue anterolateral structures of the knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 36 anterior cruciate ligament–injured patients with Segond fractures (33 male, 3 female; mean age, 23.2 ± 8.4 years) were enrolled. MRI scans were reviewed to determine the anatomic characteristics of the Segond fracture, including the following: proximal-distal (PD) length, anterior-posterior (AP) width, medial-lateral (ML) width, PD distance to the lateral tibial plateau, AP distance to the Gerdy tubercle (GT), and AP distance from the GT to the posterior aspect of the fibular head. The attachment of the anterolateral structures to the Segond fragment was then categorized as the iliotibial band (ITB) or anterolateral capsule. Interrater reliability of the measurements was determined by calculating the Spearman rank correlation coefficient. MEDLINE, Web of Science, and the Cochrane Library were searched from inception to May 2016 for the following keywords: (1) “Segond fracture,” (2) “anterolateral ligament,” (3) “knee avulsion,” (4) “lateral tibia avulsion,” and (5) “tibial plateau avulsion.” All studies describing the anatomic location of the Segond fracture and the ALL were included in the systematic review. Results: On plain radiographs, the mean distance of the midpoint of the fracture to the lateral tibial plateau was 4.6 ± 2.2 mm. The avulsed fracture had a mean PD length of 9.2 ± 2.5 mm and a mean ML width of 2.4 ± 1.4 mm. On MRI, the mean distance of the proximal fracture to the tibial plateau was 3.4 ± 1.6 mm. The mean PD length was 8.7 ± 2.2 mm, while the mean AP width was 11.1 ± 2.2 mm. The mean distance between the GT and the center of the fracture was 26.9 ± 3.3 mm, while the mean distance between the GT and the posterior fibular head was 53.9 ± 4.4 mm. The mean distance of the midpoint of the fracture to the tibial plateau was 7.8 ± 2.7 mm, while the center of the fracture was 49.9% of the distance between the GT and the posterior aspect of the fibular head. Analysis of soft tissue structures attached to the fragment revealed that the ITB attached in 34 of 36 patients and the capsule attached in 34 of 36 patients. One patient had only the capsule attached, another had only the ITB attached, and the last showed neither clearly attached. A literature review of 20 included studies revealed no difference between the previously described Segond fracture location and the tibial insertion of the ALL. Conclusion: The results of this study confirmed that while the Segond fracture occurs at the location of the tibial insertion of the ALL, as reported in the literature, MRI was unable to identify any distinct ligamentous attachment. MRI analysis revealed that soft tissue attachments to the Segond fracture were the posterior fibers of the ITB and the lateral capsule in 94% of patients.

scholarly journals Prediction of Meniscal and Ligamentous Injuries in Lateral Tibial Plateau Fractures Based on Measurements of Lateral Plateau Widening on Multidetector Computed Tomography Scans

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Jan P. Kolb ◽  
Marc Regier ◽  
Eik Vettorazzi ◽  
Norbert Stiel ◽  
Jan P. Petersen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Multidetector Ct ◽  
Lateral Meniscus ◽  
Case Series ◽  
Lateral Collateral Ligament ◽  
Tibial Plateau Fractures ◽  
Lateral Tibial Plateau ◽  
Plain Radiographs ◽  
Lateral Plateau

Background. The influence of increasing lateral plateau widening on the frequency of meniscal and ligamentous lesions in lateral tibial plateau fractures has been examined in very few studies using plain radiographs. Because the amount of this parameter cannot be measured accurately on plain radiographs, the purpose of this survey was to look for a possible correlation between the extent of lateral plateau widening, as measured on multidetector CT (MDCT) scans, and different soft-tissue injuries determined from magnetic resonance imaging (MRI). Materials and Methods. 55 patients with a lateral tibial plateau fracture were included in this retrospective case series. Patient age averaged 52.6 years (SD = 18.0). The degree of lateral plateau widening was measured on CT images. MRIs were screened for meniscal and ligamentous injuries. Results. We found a significant effect of increasing lateral plateau widening on the incidence of lateral meniscus lesions (P = 0.021), lateral collateral ligament tears (P = 0.047), and the overall quantity of meniscal and ligamentous lesions (P = 0.001). Discussion. MRIs are not widely used as a diagnostic tool in lateral plateau fractures of the tibia. Reasons might be the costs and the fact that it is a time-consuming examination. The results of this study may help to estimate the probability of specific soft-tissue lesions in lateral tibial plateau fractures based on measurements of lateral plateau widening on MDCT scans, and they may guide the decision for additional MRI and/or arthroscopically assisted repair.

Lateral and medial tibial plateau angles in normal dogs

2014 ◽  
Vol 27 (02) ◽  
pp. 135-140 ◽  
Author(s):  
M. K. Ocal ◽  
S. S. Sabanci
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Axial Rotation ◽  
T Test ◽  
Medial Tibial Plateau ◽  
Lateral Tibial Plateau ◽  
Cranial Cruciate Ligament ◽  
Significant Difference ◽  
The Mean ◽  
The Difference

SummaryTo measure lateral and medial tibial plateau angle values in isolated canine tibiae and to compare lateral and medial tibial plateau angle values between dogs based on sex and breed.Tibiae of 90 dogs from 24 different breeds were used. Photographs were taken of the medial and lateral aspects of the tibiae for measurement of the medial and lateral tibial plateau angles. Additionally, the medial tibial plateau angle was measured from radiographs of the tibiae. Two-way analysis of variance was used to test the effects of side, sex and breed on the medial and lateral tibial plateau angles as measured from photographs as well as the medial tibial plateal angles as measured from radiographs. The photographic and radiographic medial tibial plateau angles were compared by paired t-test, whereas the medial and lateral photographic tibial plateau angles were compared by t-test.When all dogs were included in the analysis, the difference between the mean medial tibial plateau angle (24.0 ± 3.19°) and the mean lateral tibial plateau angle (25.5 ± 3.84°) as measured from photographs was significant (p <0.05). The difference in the photographic medial tibial plateau angle between male and female dogs was significant (p <0.05), whereas the difference in the photographic lateral tibial plateau angle between sexes was not significant. There was a significant difference between the medial and lateral tibial plateau angles as measured from photographs in male dogs (p <0.05) but not in female dogs. Breed comparisons also showed significant differences for the photographic lateral tibial plateau angle (p <0.05).The axial rotation of the femoral condyles on the tibial plateau is probably affected by the discrepancy between the medial and lateral tibial plateau angles, and this difference in certain breeds might influence the prevalence of cranial cruciate ligament disease.

scholarly journals Comparison of articular exposure through extended lateral approaches to the tibial plateau

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0031
Author(s):  
Jannik Frings ◽  
Matthias Krause ◽  
Hüseyin Isik ◽  
Karl-Heinz Frosch
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Lateral Collateral Ligament ◽  
Joint Surface ◽  
Anatomical Reconstruction ◽  
Anterolateral Approach ◽  
Popliteus Tendon ◽  
Lateral Tibial Plateau ◽  
Lateral Epicondyle

Aims and Objectives: Comminuted lateral tibial plateau fractures pose a challenge to surgeons, resulting in non-anatomical reductions in 70-89% of all cases. Anatomical reconstruction requires the direct visualization of the joint after a fragment reduction, which is impaired using the common anterolateral approach. Although numerous lateral extended approaches are described, there is currently no data on which approach provides better visibility of the posterolateral tibial plateau. The aim of this study was to evaluate, which parts of the tibial plateau can be visualized with the use of the lateral femoral epicondyle osteotomy or the fibula osteotomy? Further, the study investigated wether the combined osteotomy of the femoral footprints of the lateral collateral ligament (LCL) and popliteus tendon (PLT) provide better access to the posterolateral joint surface than the isolated osteotomy of the femoral LCL footprint or the fibula osteotomy? Materials and Methods: Extended lateral (femoral or fibular LCL osteotomy) and posterolateral (additional femoral osteotomy of the PLT tendon) approaches were performed on twelve human cadaver knee joints. After preparing of each surgical approach, the visible joint surface was marked with diathermy. The tibial plateau was disarticulated and the markings were measured digitally with open-source processing software. Differences in mean values were tested with a paired t-test (p < 0.05). Results: The greatest articular exposition was realized by the fibula osteotomy (1011.52 ± 227.05 mm2 [86.64 ± 4.84%] compared to either osteotomy of LCL and PLT (p = 0.036) or LCL alone (p<0.001). The lateral femoral epicondyle osteotomy of the LCL including the PLT (937.45 ± 237.84 mm2 [80.29 ± 8.25 %]) exposed a significantly larger articular surface of the lateral tibial plateau than without the PLT (755.71 ± 183.06 mm2 [64.73 ± 6.51 %], p < 0.001). Conclusion: The fibula osteotomy provides the greatest articular visibility of the lateral tibial plateau compared to the lateral epicondyle osteotomy of the femoral LCL and PLT attachments. This small benefit should be critically balanced against the considerably greater soft tissue damage caused by the fibula osteotomy. The lateral femoral epicondyle osteotomy including the LCL and PLT increases lateral articular visualization without risk to neurovascular or posterolateral soft tissue structures and represents an important extended approach to treat comminuted lateral plateau fractures.

scholarly journals Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Andreas Hecker ◽  
Rainer J. Egli ◽  
Emanuel F. Liechti ◽  
Christiane S. Leibold ◽  
Frank M. Klenke
Keyword(s):  
Anterolateral Ligament ◽  
Joint Line ◽  
Coronal Plane ◽  
Rotational Stability ◽  
Current Debate ◽  
Fibular Head ◽  
Multiplanar Reformation ◽  
Tibial Insertion ◽  
Gerdy’S Tubercle ◽  
Mri Image

AbstractThe anterolateral ligament (ALL) is subject of the current debate concerning rotational stability in case of anterior cruciate ligament (ACL) injuries. Today, reliable anatomical and biomechanical evidence for its existence and course is available. Some radiologic studies claim to be able to identify the ALL on standard coronal plane MRI sections. In the experience of the authors, however, ALL identification on standard MRI sequences frequently fails and is prone to errors. The reason for this mainly lies in the fact, that the entire ALL often cannot be identified on a single MRI image. This study aimed to establish an MRI evaluation protocol improving the visualization of the ALL, using multiplanar reformation (MPR) with the goal to be able to evaluate the ALL on one MRI image. A total of 47 knee MRIs performed due to atraumatic knee pain between 2018 and 2019 without any pathology were analyzed. Identification of the ALL was performed twice by an orthopedic surgeon and a radiologist on standard coronal plane and after MPR. For the latter axial and coronal alignment was obtained with the femoral condyles as a reference. Then the coronal plane was adjusted to the course of the ALL with the lateral epicondyle as proximal reference. Visualization of the ALL was rated as “complete” (continuous ligamentous structure with a tibial and femoral insertion visible on one coronal image), “partial” (only parts of the ALL like the tibial insertion were visible) and “not visible”. The distances of its tibial insertion to the bony joint line, Gerdy’s tubercle and the tip of the fibular head were measured. On standard coronal images the ALL was fully visible in 17/47, partially visible in 27/47, and not visible in 3/47 cases. With MPR the ALL was fully visible in 44/47 and not visible in 3/47 cases. The median distance of its tibial insertion to the bony joint line, Gerdy’s tubercle and the tip of the fibular head were 9, 21 and 25 mm, respectively. The inter- (ICC: 0.612; 0.645; 0.757) and intraobserver (ICC: 0.632; 0.823; 0.857) reliability was good to excellent. Complete visualization of the ALL on a single MRI image is critical for its identification and evaluation. Applying multiplanar reformation achieved reliable full-length visualization of the ALL in 94% of cases. The described MPR technique can be applied easily and fast in clinical routine. It is a reliable tool to improve the assessment of the ALL.

scholarly journals Bilateral Avulsion Fracture of the Fibula Head of the Knee Associated with Avulsion Fracture of the Iliotibial Band: A Rare Case of Fracture Segond Associated with Arcuate Fracture

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Jonatas Brito de Alencar Neto ◽  
Clodoaldo José Duarte de Souza ◽  
Márcio Bezerra Gadelha Lopes ◽  
Maria Luzete Costa Cavalcante ◽  
Luiz Holanda Pinto Neto
Keyword(s):  
Rare Case ◽  
Avulsion Fracture ◽  
Anterolateral Ligament ◽  
Iliotibial Band ◽  
Rare Entity ◽  
Fibular Head ◽  
Segond Fracture ◽  
Avulsion Fractures ◽  
Fibula Head ◽  
Rare Case Report

Fibular head avulsion fractures are rare and are so-called the arcuate signal. Avulsion fracture of the iliotibial band and anterolateral ligament is known as a Segond fracture, and it is another rare entity. We describe the case of a 27-year-old woman who was hit by a car and suffered polytrauma, mainly suffering injuries to both knees. Radiographs of the knees showed a Segond fracture associated with the arched signal bilaterally. The aim of this study is to present a rare case report and literature review of a bilateral fibular head avulsion fracture associated with an anterolateral tibial avulsion fracture.

MANAGEMENT OF HIGH VELOCITY TIBIAL PLATEAU FRACTURES BY LIGAMENTOTAXIS USING ILIZAROV EXTERNAL FIXATOR

2021 ◽  
pp. 33-35
Author(s):  
Mayank Poddar ◽  
Abhinav Sinha ◽  
Amit Narang
Keyword(s):  
Soft Tissue ◽  
High Velocity ◽  
Bone Grafting ◽  
Tibial Plateau ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Type Iv ◽  
Schatzker Type ◽  
Duration Of Surgery ◽  
The Mean

Background: Tibial plateau fractures resulting from high energy trauma, typically Schatzker type IV, V and VI pattern fractures are difcult to deal with due to poor overlying soft tissue cover. Ligamentotaxis with ilizarov ring xator can be a suitable denitive treatment option for such injuries with fewer associated complications as compared to internal xation. Patients and Methods: 30 patients within the age group of 18-80 years with Schatzker type IV, V and VI pattern injuries were included in the study. A four ring ilizarov assembly was used with knee spanning with a proximal femoral ring. The patients were followed for 12 months and evaluation was analyzed as per Rasmussen clinical and radiological criteria. Results: The mean age of patients in our study was 39.76 years. Twenty cases were Schatzker type VI, 7 cases were Schatzker type IV (with extensive soft tissue swelling following high velocity trauma) and only 3 cases were type V. The mean duration of surgery was 47±12 mins without bone grafting and 72±14 mins with bone grafting. The mean interval from injury to surgery was 2.36 days (range 1-5 days). Rasmussen total anatomical outcome was excellent in 14 patients(46.66%) and good in 16 patients(53.33%). Rasmussen total functional outcome was excellent in 21 patients(70%) and good in 9 patients(30%). Final Outcome was excellent in 22 patients(73.33%) and good in 8 patient(26.66%). Discussion: High velocity tibial plateau fractures, when treated with internal xation and plating, carry a higher risk of associated complications ranging from deep infections to even compartment syndrome. The rate of re-operation following internal xation in such injuries has been high with most of the re-surgeries being required within one year of primary xation which adds to the morbidity of the patient. Ligamentotaxis with ilizarov ring xation as denitive treatment in such cases can be a fruitful operation with lesser complications and early return to previous level of activity.

scholarly journals Schatzker II tibial plateau fractures: Anatomically precontoured 3.5 mm locking compression plates allow for improved patient outcome

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0002
Author(s):  
Wolf Christian Prall ◽  
Thomas Kusmenkov ◽  
Julian Fürmetz ◽  
Hermann O. Mayr ◽  
Wolfgang Böcker
Keyword(s):  
Patient Outcome ◽  
Internal Fixation ◽  
Tibial Plateau ◽  
Joint Surface ◽  
Lateral Tibial Plateau ◽  
Locking Compression Plates ◽  
Bone Graft Substitutes ◽  
The Mean ◽  
Group B

In the operative treatment of split depression factures to the lateral tibial plateau, the reconstruction of the depressed joint surface is eagerly sought after. The subchondral bony defect often requires bone grafting or bone graft substitutes. At least equally important is the achievement of an internal fixation that provides the greatest possible support for the fragile joint surface fragments. The design of the anatomically precontoured locking compression plates features a higher number of locking screws underneath the joint surface and permits the screw placement closer to the subchondral zone compared to conventional plates. Whether the altered design results in better patient outcome is analysed in this study. Our databank was searched for Schatzker II fractures from 2012 until 2015. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm locking compression plates (A) or conventional 4,5 mm L-shaped locking compression plates and screws (B) were included and retrospectively evaluated. CT-scans, radiographs in two planes and in full length standing mode, if available, were analysed. Details of the operative procedures and secondary events were determined. Objective outcome parameters were collected from the patient records, subjective outcome parameters were assessed in a survey and WOMAC as well as Rasmussen functional knee scores were calculated. A total of 36 patients were included (A=20, B=16). The mean patient age, the ratio male to female and the mean follow up were comparable. CT-scans revealed an equal mean size of the depressed joint surface (A: 23.7 x 25.3 mm; B: 23.9 x 24.0 mm) and maximal depression depth (11.2 and 11.8 mm). The duration of the operation, the frequency of utilizing bone grafts or bone graft substitutes and of lateral meniscus repair as well as the rate of subsequent implant removal were also comparable. In the early postoperative controls, the radiological assessment according to Rasmussen revealed a mean score of 9.1 (A) and of 8.5 (B). During follow up, the mean score decreased to 8.1 and 6.7 for A and B, respectively. This difference was statistically significant (p<0.05). A valgus deviation was more often observed in group B. Both, the WOMAC and the Rasmussen functional knee score revealed lower mean values for group B in the final evaluation. The progressive decrease of the Rasmussen radiological score for the conventional 4,5 mm L-shaped locking compression plates and screws was predominantly due to a secondary loss of reduction and an increasing valgus deviation. The altered design of the anatomically precontoured 3.5 mm locking compression plate seems to prevent more sufficiently the reduced joint surface fragments from sintering over time. The anatomically precontoured 3.5 mm locking compression plate allows for improved patient outcome and should closely be considered for internal fixation of split depression fractures to the lateral tibial plateau.

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