This young football player presents with a painful, swollen knee following an innocuous twisting injury. They describe a feeling of “something going out of place”, a snapping sensation and immediate pain. They were unable to continue.
This AP X-ray image shows a Segond fracture – an avulsion from the lateral tibial condyle. The injury is best appreciated on an AP view.
When a Segond fracture is present one should be very suspicious of an anterior cruciate ligament injury (or another significant knee injury). It is caused by an avulsion from the lateral aspect of the lateral tibial condyle just below the tibial plateau. The injury typically occurs with internal rotation of the tibia on a flexed knee. While the fracture itself requires no specific treatment the associated injuries typically require surgical management. When this injury is shown on an x-ray, consideration should be given to further high-tech imaging to look for associated injuries.
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