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Segond Fracture

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21. Fracture, Knee (Overview)

(3):631-53. . Gray SD, Kaplan PA, Dussault RG. Acute knee trauma: how many plain film views are necessary for the initial examination?. Skeletal Radiol . 1997 May. 26(5):298-302. . Davis DS, Post WR. Segond fracture: lateral capsular ligament avulsion. J Orthop Sports Phys Ther . 1997 Feb. 25(2):103-6. . Hall FM, Hochman MG. Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skeletal Radiol (...) Fracture, Knee (Overview) Knee Fracture: Background, Epidemiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. processing > Knee Fracture Updated: Oct 17, 2015 Author: Mark Steele, MD; Chief

2014 eMedicine Emergency Medicine

22. Fracture, Knee (Follow-up)

and morphological findings and impact on outcome. Skeletal Radiol . 2015 Aug 20. . Walker CW, Moore TE. Imaging of skeletal and soft tissue injuries in and around the knee. Radiol Clin North Am . 1997 May. 35(3):631-53. . Gray SD, Kaplan PA, Dussault RG. Acute knee trauma: how many plain film views are necessary for the initial examination?. Skeletal Radiol . 1997 May. 26(5):298-302. . Davis DS, Post WR. Segond fracture: lateral capsular ligament avulsion. J Orthop Sports Phys Ther . 1997 Feb. 25(2):103-6 (...) . . Hall FM, Hochman MG. Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skeletal Radiol . 1997 Sep. 26(9):553-5. . Hardy JR, Chimutengwende-Gordon M, Bakar I. Rupture of the quadriceps tendon: an association with a patellar spur. J Bone Joint Surg Br . 2005 Oct. 87(10):1361-3. . Nichol G, Stiell IG, Wells GA. An economic analysis of the Ottawa knee rule. Ann Emerg Med . 1999 Oct. 34(4 Pt 1):438

2014 eMedicine Emergency Medicine

23. Exam Series: Guide to the Knee Exam

obtain knee radiographs after acute injury for patients who have Age =>55 Isolated tenderness at the patella Inability to flex the knee to 90 degrees Inability to bear weight immediately and in the emergency department for four steps Children are more prone to fractures as their ligaments are stronger than bones, so there is a low threshold to order X-rays in children. If there is suspicion for a tibial plateau fracture three views should be ordered: AP, lateral, and tunnel view. A segond fracture (...) – a small tibial avulsion fracture – may be indicative of an occult tibial plateau fracture or ACL tear. A Segond Fracture 11 CT imaging may be indicated if there is a traumatic mechanism and a high suspicion of fracture not seen on X ray. CT angiography may also be indicated if there is suspected popliteal artery injury and in all knee dislocations. MRI can be used to further assess for ligamentous injury. Although this does not guide management in the emergency department or acute setting it is often

2018 CandiEM

24. Chronic Knee Pain

3 Chronic Knee Pain Variant 5: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph demonstrates signs of prior osseous injury (ie, Segond fracture, tibial spine avulsion, etc). Next imaging procedure. Procedure Appropriateness Category Relative Radiation Level MRI knee without IV contrast Usually Appropriate O CT arthrography knee May Be Appropriate ? CT knee without IV contrast May Be Appropriate ? Aspiration knee Usually Not Appropriate Varies CT (...) ) initial radiograph is normal or demonstrates a joint effusion; (3) initial radiograph demonstrates osteochondritis dissecans (OCD), loose bodies or history of cartilage, or meniscal repair; (4) initial radiograph demonstrates osteoarthritis or chondrocalcinosis; and (5) initial radiograph demonstrates signs of prior (chronic) knee injury (ie, Segond fracture, tibial spine avulsion, etc). To evaluate knee pain associated with other conditions, please refer to the following ACR Appropriateness Criteria

2018 American College of Radiology

25. CRACKCast E057 – Knee and Lower Leg

to osteoporotic bones Most involve the lateral plateau and are INTRA-ARTICULAR A segond fracture = bone avulsion of the lateral tibial plateau Seen on the AP knee x-ray as a lateral avulsion # Lateral capsular ligament avulsion Can be associated with an ACL tear and rotatory instability Usually sports related injury: knee flexion, internal rotation and varus Examination: Key to examine the distal pulses (high risk of popliteal artery injury) Must assess peroneal nerve function (foot dorsiflexion) Consider (...) videos on Occult Knee Injuries and Rosen’s in Perspective “Most complex joint in the body” Flexion, extension, rotation, gliding, rolling Joins the two longest levers in the body (tibia and femur) Main ER goals: Identify repairable vascular injuries Reducing dislocations Stabilizing fractures Giving antibiotics when needed Has two joints: Tibio-femoral Femur = two condyles These articulate with the tibia, cushioned with the medial and lateral menisci Four strong ligaments anchor the tibia

2017 CandiEM

26. Magnetic Resonance Imaging Evaluation of the Anterolateral Ligament in Acute Anterior Cruciate Ligament Injuries in an Adolescent Population. (Abstract)

(trauma for <3 weeks before examination) were retrospectively evaluated with MRI over 24 months (January 2016-December 2017). Among this population, ALL was classified as not visible, normal, or injured. Injuries were separated into strains (partial injuries), complete injuries, or Segond fractures. Possible abnormalities of the menisci, collateral ligaments, popliteal tendon, posterior cruciate ligament (PCL), iliotibial tract (ITT), and bone injuries were evaluated. Associations were calculated (...) between ALL injuries and injuries of these other knee structures, as well as age and gender.ALL was visible in 171 of the 184 MRI-evaluated knees (92.9%). ALL was considered normal in 68 (39.8%) and damaged in 103 (60.2%) patients. ALL injuries were considered partial in 56 (54.4%) and total in 44 (42.7%) cases. Only 3 (2.9%) cases were Segond fractures. ALL injuries were associated with ITT (P < .0001), lateral meniscus (P = .04), lateral collateral ligament (P = .01), popliteal tendon (P = .001

2019 Arthroscopy

27. Anterolateral Ligament of the Knee: Diagnosis, Indications, Technique, Outcomes. (Abstract)

and with increasing knee flexion angles (>35). Clinically, when a patient presents with an anterior cruciate ligament (ACL) injury, clinical examination (pivot shift test), radiography (Segond fracture), ultrasound, and 3-dimensional magnetic resonance imaging are useful to assess a combined ALL injury. The following indications for ALL reconstruction are now well established: ACL revision, high-grade pivot shift test, chronic ACL rupture, young patients, pivoting activities, and patients undergoing medial

2019 Arthroscopy

28. Editorial Commentary: The Anterolateral Ligament Really Exists, Now Show Me How to Find It. (Full text)

Editorial Commentary: The Anterolateral Ligament Really Exists, Now Show Me How to Find It. The anterior lateral complex is commonly associated with anterior cruciate ligament (ACL) injury. This has been evident since the description of the Segond fracture and by the use of lateral extra-articular tenodesis for ACL injury. Although lateral extra-articular tenodesis has been mostly given up owing to a preference for anatomic ACL reconstructions, it is gaining interest as an adjunct to ACL

2019 Arthroscopy PubMed abstract

29. Surgical indications for anterior cruciate ligament reconstruction combined with extra-articular lateral tenodesis or anterolateral ligament reconstruction (Full text)

are: anterior cruciate ligament revision, physical examination with pivotal shift grade 2 or 3, practice of sport with pivot mechanism and/or high level mechanism, ligament laxity and Segond fracture; Secondly, the following may also be indications: chronic anterior cruciate ligament injury, age less than 25 years old, and radiological sign of lateral femoral condyle depression. However, it is worth mentioning that more studies are still needed to prove these trends.

2018 Revista brasileira de ortopedia PubMed abstract

30. The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting. (Full text)

and biomechanical properties of the ALC. The evidence for and against utilisation of ALC reconstruction was also discussed, generating a number of consensus statements by following a modified Delphi process. Key points include that the ALC consists of the superficial and deep aspects of the iliotibial tract with its Kaplan fibre attachments on the distal femur, along with the ALL, a capsular structure within the anterolateral capsule. A number of structures attach to the area of the Segond fracture including

2018 Knee Surgery, Sports Traumatology, Arthroscopy PubMed abstract

31. Evaluation of Anterolateral Ligament Injuries and Concomitant Lesions on Magnetic Resonance Imaging After Acute Anterior Cruciate Ligament Rupture. (Abstract)

magnetic resonance imaging, we evaluated the presence of ALL injury and concomitant lesions within 3 weeks of the injury. Meniscal tears were also identified on representative arthroscopic images.Following the inclusion criteria, we included a total of 275 patients in this study. The mean duration from ACL rupture to magnetic resonance imaging examination was 5.0 ± 6.0 days. We visualized ALL in 98.2% of patients, of whom 64% had ALL injuries (10.9%, 4.7%, and 48.4% were complete ruptures, Segond (...) fracture, and partial ruptures, respectively). We found that ALL injuries were most commonly found in the femoral location. The intra- and interobserver agreement on the severity of ALL injury (κ = 0.83 and 0.81, respectively) and the location of ALL injury (κ = 0.85 and 0.84, respectively) were excellent. The association between ALL injury and lateral meniscal lesions was significant (P = .03). In particular, the proportion of the lateral meniscal posterior horn radial tears was significantly larger

2018 Arthroscopy

32. Acute Trauma to the Knee

The RRL for the adult procedure is ?. ?? CT knee without and with IV contrast 1 The RRL for the adult procedure is ?. ?? Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level ACR Appropriateness Criteria ® 2 Acute Trauma to Knee Clinical Condition: Acute Trauma to the Knee Variant 3: Adult or child >1 year old. Fall or twisting injury with either no fracture or a Segond fracture seen on a radiograph, suspect internal derangement (...) no fracture or a Segond fracture seen on a radiograph, suspect internal derangement. Next study. MRI is considered the optimal imaging modality for identifying meniscal, ligament, chondral, and nondisplaced bone injuries around the knee [42,43]. Numerous studies have shown that MRI has a high diagnostic accuracy in identifying traumatic intra-articular knee lesions [44-46]. This is particularly true when strict diagnostic criteria are used [44], and this applies to both spin-echo imaging and fast spin

2014 American College of Radiology

33. How to Test the Anterolateral Ligament With Ultrasound (Full text)

the anterolateral aspect of the knee in patients with an anterior cruciate ligament tear. We use a simple technique that starts by locating the tibial end of the ALL. The lateral inferior genicular artery is a reliable landmark in this context. The analysis is dynamic in addition to being static. To determine if the ALL is injured, we look for a lack of tension on the ALL when the knee is internally rotated and for a Segond fracture. We believe that it is essential to start evaluating the ALL by its tibial end

2017 Arthroscopy techniques PubMed abstract

34. Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee (Full text)

the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond (...) fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary

2017 Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology PubMed abstract

35. Combined reconstruction of the anterior cruciate ligament associated with anterolateral tenodesis effectively controls the acceleration of the tibia during the pivot shift. (Abstract)

-contact sport, revision ACL reconstruction (besides STG (semitendinosus-gracilis graft) repair), subjective explosive rotational laxity, Segond fracture, and TELOS value of >10 mm. Standardized pre- and postoperative pivot shift tests were immediately performed under anesthesia in both knees.Forty-three patients were included. Mean preoperative variations in tibial acceleration in the healthy and injured knees were 1.2 ± 0.1 and 2.7 ± 0.3 m/s2, respectively, p < 0.01. A statistically significant

2017 Knee Surgery, Sports Traumatology, Arthroscopy

36. The anterolateral complex in anterior cruciate ligament deficient knees demonstrate sonographic abnormalities on high-resolution sonography. (Abstract)

and the posterior and deep aspect of the iliotibial band superficial to the origin of the lateral collateral ligament. The ALC was followed distally to the broad insertion centralizing to the area posterior to Gerdy's tubercle. The appearance of the distal insertion of the ALC was classified based both on echogenicity and on the presence of a Segond fracture as follows: Grade 0: isoechoic to the rest of the ALC, Grade 1: hypoechoic, Grade 2: anechoic, and Grade 3: Segond fracture. The uninjured side

2017 Knee Surgery, Sports Traumatology, Arthroscopy

37. Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament. (Abstract)

. The association of an ALL injury with these other knee structures as well as sex and age was calculated.Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial (...) plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury.ALL injuries are present in approximately 40% of ACL injuries, and a minority of these are Segond fractures. These injuries are associated with peripheral ligament injuries, anterolateral structures lesions and bone contusions, but there is no association with meniscal

2017 Knee Surgery, Sports Traumatology, Arthroscopy

38. Funtabulously Frivolous Friday Five 183

myiasis caused by botfly larvae. The female botfly will deposit eggs on a mosquito’s abdomen, once the mosquito engages in its 3 course meal (i.e. you) the eggs hatch and the larvae can enter the skin. When the botfly is mature it will exit the site. If that is not acceptable to you, simply add a little bacon to the site for approximately 3 hours and this will encourage the botfly out ……. forceps at the ready! [ ] Question 3 A Segond fracture is a small avulsion of the lateral tibial plateau (...) associated with ACL and increasingly PCL disruption. How did Mr Paul Segond investigate this injury? Perhaps due to the lack of X-rays or just good access to cadavers, he delivered excessive internal rotation onto 38 cadaveric knees in flexion and observed 17 of the knees to have a lateral tibial condyle avulsion fractures. Henry Milch in 1936 was the first to X-ray the Segond fracture. [ ] Question 4 Who has survived the most radiation in their lifetime? Albert Stevens As part of the Manhattan Project

2017 Life in the Fast Lane Blog

39. Historical perspective on the "discovery" of the anterolateral ligament of the knee. (Abstract)

of many historical studies. In 1879, Paul Ferdinand Segond described a tibial plateau fracture in which he noted a pearly band reinforcing the joint capsule. Other anatomists had their suspicions about this ligament; it was described by Vallois in 1914 in his thesis and extensively studied by Jost in 1921. References to it can be found in comparative anatomy studies. This historical review serves as a reminder that understanding and treating knee sprains is not something new.V.

2016 Knee Surgery, Sports Traumatology, Arthroscopy

40. Prevalence and Classification of Injuries of Anterolateral Complex in Acute Anterior Cruciate Ligament Tears. (Abstract)

hemorrhage extended from the area of the ALL and capsule to the posterolateral capsule. Type III: complete transverse tear involving the area of the ALL near its insertion to the lateral tibial plateau, distal to the lateral meniscus. Type IV: bony avulsion (Segond fracture). The pivot-shift test was repeated intraoperatively after repair of lateral tears before the ACL reconstruction.Although magnetic resonance imaging was able to detect only bony injuries (Segond fracture), macroscopic tears

2016 Arthroscopy

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