What is Segond Fracture?
Segond fractures occur when a piece of the upper part of the bone on the side of your shinbone (the lateral proximal tibia) is pulled off. This is usually at the spot where a knee ligament called the anterolateral ligament attaches. Importantly, these fractures typically indicate a more serious knee injury: a tear in the anterior cruciate ligament (ACL).
A plain x-ray showing a Segond fracture means doctors need to check for other possible knee injuries as well. This is because a Segond fracture rarely happens on its own. The exception might be in children, where isolated Segond fractures are more common, but still not the usual situation. Even then, a comprehensive check for injuries to the knee ligaments should be carried out, as these are important for stability and movement of the knee.
What Causes Segond Fracture?
Segond fractures occur due to a specific movement of the knee, involving a twisting inward motion and pressure. These fractures were first noted by Paul Segond in his 1879 studies on knee injuries. Modern imaging methods have linked Segond fractures to tears in the ACL, another part of the knee.
Segond also discovered a fibrous band at the point of the injury, which he identified as the anterolateral ligament. That being said, recent MRI studies have been unable to find any particular parts attached to this ligament. However, they did reveal attachment of posterior capsule and iliotibial band fibers to the Segond fragment, a bone fragment involved in such fractures.
These discussions about the ligaments and fragments connected to the Segond fracture remain controversial.
Risk Factors and Frequency for Segond Fracture
Segond fractures are very often linked with ACL (anterior cruciate ligament) ruptures, occurring alongside them in 75% to 100% of cases. However, only around 9-12% of all ACL ruptures are associated with a Segond fracture.
ACL ruptures are a common type of injury to the joints, with about 68.6 cases occurring per 100,000 people every year in the United States. These ruptures happen slightly more often in men than in women. The most common age for men to experience an ACL rupture is between 19 and 25 years old, while for women it’s between 14 and 18 years old.
- Segond fractures often occur with ACL ruptures, in 75% to 100% cases.
- However, Segond fractures are only seen in about 9-12% of all ACL ruptures.
- ACL ruptures are a frequent joint injury in the U.S., with a rate of 68.6 per 100,000 people every year.
- ACL ruptures are slightly more common in men than in women.
- The age group most prone to ACL ruptures are men aged 19-25 and women aged 14-18.
Signs and Symptoms of Segond Fracture
Segond fractures are typically associated with a type of knee injury known as an ACL rupture. Like ACL ruptures, Segond fractures usually happen when the knee is twisted. Patients often hear a popping sound followed by pain, swelling, limited knee movement, and difficulty moving around.
To find a Segond fracture, a doctor usually looks at an X-ray of the knee. Because these fractures often indicate an ACL rupture, it’s crucial to check the knee for signs of this type of injury. One common test for ACL tears is Lachmann’s test. The doctor may also use another test, the anterior drawer test. In addition, they will likely assess the other ligaments in the knee to make sure they’re not damaged. This might involve tests like the posterior drawer test, varus/valgus stress testing, and pivot shift testing.
Keep in mind:
- Symptoms of a Segond fracture include a popping sound, pain, swelling, limited knee movement, and difficulty moving around.
- It’s usually found through a knee X-ray.
- Since this type of fracture often means an ACL rupture, further tests like Lachmann’s test and the anterior drawer test are likely.
- The doctor will also probably check your other knee ligaments for any damage.
Testing for Segond Fracture
A Segond fracture is a type of bone break that can normally be identified by using a simple X-ray. This fracture appears as a small, broken off piece of bone (avulsion fracture) in a certain view of the knee on the upper part of the shinbone (proximal tibia).
However, since this type of injury often comes with damages to the ligaments and sometimes, to the knee’s shock absorbers (meniscus), further evaluation is needed. This is where a magnetic resonance imaging scan (MRI) is used. This advanced imaging technology can reveal more subtle signs of a Segond fracture and also identify any related ligament injuries.
While computerized tomography (CT) scans offer a higher accuracy in diagnosing fractures, they are not commonly used in diagnosing Segond fractures. This is because MRIs are preferred for detecting the particular ligament injuries in the knee often associated with this type of fractures.
Treatment Options for Segond Fracture
If someone injures their knee, the first step in treatment should involve simple care at home. This includes resting the injured knee, keeping it raised when possible, using painkillers, and applying ice to the knee. In order to move around more easily, patients might need crutches or walking aids. A knee brace can also be used early on to provide extra support to the knee.
Surgeries for this type of injury tend to focus on related injuries and don’t usually include directly treating a Segond fracture, a particular type of knee fracture. Current research shows that it’s not usually necessary to surgically treat a Segond fracture. This type of fracture doesn’t make the knee more likely to suffer further damage if a surgery called an ACL reconstruction is performed.
In some cases, it may be beneficial to surgically repair a Segond fracture as it may improve the knee’s ability to rotate. Depending on the fracture’s features and size, it could be fixed with sutures, suture anchors, or screws. Surgery to repair Segond fractures has been shown to have good results with very few complications. However, these results were not compared to a group of patients who didn’t have this surgery.
Every surgical procedure should be considered carefully with the patient involved in deciding the best course of action. This decision will depend on several factors, including the patient’s other health issues, how active they are, their personal expectations, and their chances of a successful outcome.
No matter if a patient chooses surgery or not, they’ll need some form of physical therapy from a team of professionals. Therapy will help them recover, and they may find a brace useful for adding support and comfort to their knee.
What else can Segond Fracture be?
The “Arcuate sign” refers to a type of fracture where the fibular head, a part of your leg bone, is torn away. It can often be confused with another kind of fracture known as a Segond fracture when doctors look at X-rays. This kind of injury usually occurs when the ligaments at the back and side of the knee pull away from the fibular head because of some form of trauma to the knee. Like Segond fractures, this sign is a classic symptom of knee damage and instability. Therefore, it requires the same level of investigation. However, there are slight differences that can be spotted on normal X-rays. An Arcuate fracture is usually more horizontal, and it’s also located more to the side and back than a Segond fracture would normally be.
What to expect with Segond Fracture
Generally, the outlook for a Segond fracture, which is a type of knee injury, is good. Current understanding suggests that there isn’t any significant benefit to surgically repairing this type of fracture. Also, having a Segond fracture doesn’t seem to increase the likelihood of needing additional surgeries in the future.
The primary factor affecting the overall outcome is whether any other tied injuries in the knee (like ligament damage) are properly treated. If these are appropriately addressed, patients usually do well in their recovery. However, any changes in the natural functioning of the knee can increase the risk of osteoarthritis – a type of joint disease.
It’s important to note that having a ruptured ACL, a major knee ligament, often leads to osteoarthritis in many patients. While rebuilding the ruptured ACL can’t completely prevent osteoarthritis, it has been found to reduce its occurrence.
Possible Complications When Diagnosed with Segond Fracture
The main short-term complications of a Segond fracture typically consist of continuous pain and stiffness. There are also potential complications if an ACL reconstruction surgery is performed. Although this surgery is considered relatively safe, with less than 1% risk of complications from the surgical wound. Deep vein thrombosis and pulmonary embolism risks have been reported as very minor, only noted in less than half a percent of surgeries. Debates are ongoing about the necessity of preventing blood clots after knee ligament repair, and the decision to provide blood-thinning medication after surgery is generally made by the surgeon on a patient-by-patient basis, considering each individual’s specific health conditions.
Common Short-term Complications:
- Ongoing pain
- Stiffness
Potential Complications from ACL Reconstruction Surgery:
- Under 1% risk of wound complications
- Deep vein thrombosis (less than 0.5% risk)
- Pulmonary embolism (less than 0.5% risk)
Preventing Segond Fracture
Teaching patients about Segond fractures and ACL ruptures can be quite complex. These injuries are most often the result of sports or recreational activities. Women especially can lower their risk of knee injury by doing exercises that strengthen the hamstring muscles and by improving the way they land. However, it’s important to note that regular physical activity shouldn’t be limited in an attempt to avoid these types of injuries. Exercise is crucial for maintaining good mental health and a healthy heart.
