There is more to this than meets the eye- Avulsion fractures of knee

Congress:

ECR 2019

Poster Number:

C-3258

Type:

Educational Exhibit

Keywords:

Musculoskeletal joint, Conventional radiography, MR, Education, Trauma

Authors:

M. C. SOWRABHA, B. Nagabhushana Reddy, P. Reddy, B. B. Das, S. T. Prabhakar, S. Viswamitra; BANGALORE/IN

DOI:

10.26044/ecr2019/C-3258

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-3258

Fig. 1: Diagrammatic representation of attachments at knee joint

Fig. 2: Summary of attachment of ligaments and tendon of knee joint

$Fig. 3: Diagrammatic representation of Segond fracture$

Fig. 3: Diagrammatic representation of Segond fracture

$Fig. 4: Segond fracture$

Fig. 4: Segond fracture

Learning objectives

OUTLINE / TABLE OF CONTENTS: 2000 knee radiographs and MRIs were reviewed between 2016 to 2018 which revealed 10 various patterns of avulsion injuries were detected on imaging which are as follows Segond fracture , Reverse segond fracture , ACL avulsion fracture , PCL avulsion fracture, Arcuate complex avulsion fracture , Biceps femoris tendon avulsion fracture, Quadriceps tendon avulsion fracture , Iliotibial band avulsion fracture, Proximal and distal patellar tendon avulsion fractures. Teaching points: 1. To familiarise the reader with various types of the avulsions...

Background

• The Knee is a complicate joint with numerous tendinous, ligamentous, and meniscal attachments, which make it particularly vulnerable to complex injuries after trauma. • A variety of avulsion fractures of the knee can occur, including Segond and reverse Segond fractures; avulsions of the anterior and posterior cruciate ligaments; arcuate complex avulsion; iliotibial band avulsion; avulsions of the biceps femoris, semimembranosus, and quadriceps tendons; Sinding-Larsen-Johansson syndrome; and Osgood-Schlatter disease. • First imaging modality of choice is conventional radiography and these fractures often have a subtle...

Findings and procedure details

SEGOND FRACTURE • Most common avulsion described in the knee joint . • Cortical avulsion of the middle third of the lateral capsular ligament Mechanism- Internal rotation of knee and Varus stress. Imaging- Lateral capsular sign Associations: • Anterior cruciate ligament and meniscal tear • Avulsion of the fibular attachment of the long head of the biceps femoris tendon and the fibular collateral ligament • Rarely can be seen with avulsion of the ACL from its insertion anterior to the tibial eminence. Diagrammatic representation of...

Conclusion

CONCLUSIONS The knee is a complex joint with numerous tendinous, ligamentous, and meniscal attachments, which leave it vulnerable to complex injuries after trauma. A variety of avulsion fractures of the knee can be seen and often have a subtle appearance at conventional radiography. It is important to identify the pattern of injury and maintain an understanding of the frequent substantial underlying damage it signifies. By recognizing the significance of these injuries at the time of initial presentation, radiologists can facilitate appropriate patient work-up in the...

Personal information

References

REFERENCES ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY 1. Dietz GW, Wilcox DM, Montgomery JB. Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology. 1986 May;159(2):467–9. 2. Woods GW, Stanley RF, Tullos HS. Lateral capsular sign: x-ray clue to a significant knee instability. Am J Sports Med. 1979 Feb;7(1):27–33. 3. Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol. 1988 Dec;151(6):1163–7. 4. Kose O, Ozyurek S, Turan A, Guler F. Reverse Segond...