Reverse Segond fracture is one of the avulsion fracture of the knee, which is due to avulsion of the deep fibers of the medial collateral ligament (also known as the menisciotibial or coronary ligament) involving the medial proximal tibia adjacent to the articular surface. It is the opposite of the Segond fracture, which involves the lateral proximal tibia.
The reverse Segond fracture is thought to result following external rotation of the knee, with applied valgus stress 1 (c.f. Segond fracture: internal rotation and varus stress).
Unlike the Segond, which is often seen with sporting injury, the reverse Segond appears to occur with higher velocity injuries, such as being struck by a motor vehicle 2, and may be associated with knee dislocation.
This cortical fracture is thought to result from avulsion of the deep capsular component of the medial collateral ligament 1.
The characteristic finding is a small, elliptic bone fragment arising from the medial articular surface of the proximal tibia.
The finding of this injury on plain film or CT should prompt further evaluation with MRI, as these injuries are commonly associated with:
- medial meniscus tears
- posterior cruciate ligament (PCL) injuries, ranging from intrasubstance tears to avulsion
MRI will also demonstrate disruption of the medial collateral ligament. There may be associated lateral tibial plateau compression.
- 1. Gottsegen CJ, Eyer BA, White EA et-al. Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics. 2008;28 (6): 1755-70. doi:10.1148/rg.286085503 - Pubmed citation
- 2. Escobedo EM, Mills WJ, Hunter JC. The "reverse Segond" fracture: association with a tear of the posterior cruciate ligament and medial meniscus. AJR Am J Roentgenol. 2002;178 (4): 979-83. AJR Am J Roentgenol (citation) - Pubmed citation
- 3. Bucholz RW, Heckman JD. Rockwood and Green's fractures in adults. (2009) ISBN:1605476773. Read it at Google Books - Find it at Amazon
The knee is a complex synovial joint that can be affected by a range of pathologies:
- bone and cartilage
- distal femoral condyle fracture
- tibial plateau fracture (classification)
- patella fracture
avulsion fractures of the knee
- Segond fracture
- reverse Segond fracture
- anterior cruciate ligament avulsion fracture
- posterior cruciate ligament avulsion fracture
- arcuate complex avulsion fracture (arcuate sign)
- biceps femoris avulsion fracture
- iliotibial band avulsion fracture
- semimembranosus tendon avulsion fracture
- Stieda fracture (MCL avulsion fracture)
- patella fracture
- chronic avulsion injuries
- chondromalacia patellae
- osteoarthritis of the knee
- osteochondral defects
- osteochondritis dissecans of the knee
- pattern of bone contusion in knee injuries
- knee fractures
- meniscal lesions
- synovial lesions
- fat pad
- popliteal fossa