Dr. Imran Lasker, consultant radiologist, recently hosted the Monthly Case Webinar #27, providing valuable insights on a range of diagnostic imaging cases. This blog post summarizes key takeaways from the webinar, focusing on the clinical and diagnostic content discussed.
Segond Fracture: A Key Indicator of ACL Injury in Radiology
In the world of orthopedic radiology, certain subtle findings can have significant implications for patient care. One such finding is the Segond fracture, a small avulsion fracture that serves as a crucial indicator of potential anterior cruciate ligament (ACL) injury. In this blog post, we'll explore the Segond fracture, its radiological appearance, and its importance in diagnosing ACL injuries.
What is a Segond Fracture?
A Segond fracture is a type of avulsion fracture that occurs on the lateral aspect of the proximal tibia. It's named after French surgeon Paul Segond, who first described it in 1879. While the fracture itself is small, its presence is highly associated with ACL injuries, making it a valuable diagnostic sign for radiologists and orthopedic surgeons.
Radiological Appearance
The classic appearance of a Segond fracture on an anteroposterior (AP) radiograph of the knee is that of a small, elliptical bone fragment adjacent to the lateral tibial plateau. This fragment is typically less than 10 mm in length and is projected parallel to the lateral tibial cortex.
As Dr. Lasker points out in the webinar, "When you see a Segond fracture, you have to be concerned there's an underlying ACL injury."
Association with ACL Injuries
The Segond fracture is highly associated with ACL tears. In fact, studies have shown that up to 75-100% of patients with a Segond fracture also have an ACL tear. This strong correlation makes the Segond fracture an important radiological sign for diagnosing ACL injuries, especially in cases where the ACL tear itself may not be directly visible on plain radiographs.
Additional Imaging
While the Segond fracture can be identified on plain radiographs, further imaging is often necessary to fully evaluate the extent of knee injuries. As Dr. Lasker demonstrates in the webinar, MRI is particularly useful for assessing associated soft tissue injuries, including ACL tears.
"You can see quite a significant amount of loss of this normal architecture of the ACL,"
Dr. Imran Lasker explains while reviewing the MRI images.
"The ACL should be a really straight linear thing, but this is completely kind of frazzled."
Clinical Implications
The presence of a Segond fracture on radiographs should prompt further investigation for ACL injury, even if the patient's clinical presentation is not typical for an ACL tear. This can lead to earlier diagnosis and more appropriate management of ACL injuries, potentially improving patient outcomes.
Conclusion
The Segond fracture, while small, plays a significant role in the radiological diagnosis of ACL injuries. Its presence on plain radiographs should alert radiologists and clinicians to the high likelihood of an associated ACL tear, guiding further imaging and clinical management decisions.
As radiologists and orthopedic specialists, staying attuned to these subtle yet important findings is crucial for providing the best possible care for our patients. By recognizing the significance of the Segond fracture, we can contribute to more accurate and timely diagnoses of ACL injuries.
What's your experience with Segond fractures in your practice? Have you found them to be a reliable indicator of ACL injuries? Share your thoughts and experiences in the comments below!
At Collective Minds Radiology, we're committed to advancing radiological knowledge and improving patient care through collaborative learning. Our platform connects healthcare professionals worldwide, facilitating the sharing of expertise and insights on cases like Segond fractures and ACL injuries. To learn more about how you can be part of our global radiology community, visit www.cmrad.com.
This blog post is based on insights from The Monthly Case Webinar #28 Case Collection on Collective Minds Radiology. The webinar was hosted by me, Dhaanish Parvez, Product Specialist at Collective Minds.
Reviewed by: Pär Kragsterman on October 16, 2024
