Disclosures: Corey Spector, DO: No financial relationships or conflicts of interest

Case Diagnosis: Segond fracture with associated ligamentous injuries

Case Description or Program Description: A 19-year-old male presented as a level one trauma with significant left knee pain following a motor vehicle collision as a restrained driver.

Setting: Tertiary-care teaching hospital

Assessment/Results: Imaging demonstrated a left femoral shaft fracture; left Segond fracture; and left ACL, MCL, and PCL tear. He underwent intramedullary nailing of the left femur. He was discharged to acute inpatient rehabilitation. He initially ambulated fifteen feet with a rolling walker and maximal assistance, utilizing a Bledsoe brace for left knee stabilization. At discharge two weeks later, he ambulated two hundred feet independently using a rolling walker. One week following discharge, he ambulated three hundred feet using an axillary crutch.

Discussion (relevance): A Segond fracture is an avulsion fracture of the lateral proximal tibia at the attachment of the anterolateral ligament and is highly associated with ACL rupture. Etiology includes forced internal rotation with varus stress to a flexed knee. Segond fractures present with an ACL rupture in 75-100% of cases; however, ACL ruptures present with a Segond fracture in only 9-12% of cases. Presentation involves swelling, decreased range of motion, and difficulty ambulating. Diagnosis includes radiographs showing a bony fragment in the anteroposterior view of the knee on the lateral aspect of the proximal tibia. An MRI is required for further evaluation of underlying ligament or meniscal injury, which may identify more subtle Segond fractures. Initial treatment is supportive, including rest, analgesia, and ice. Surgical intervention is directed at underlying injuries, as opposed to the Segond fracture itself. Direct repair of the Segond fracture restores rotational stability of the knee. Regardless of surgical vs conservative treatment, patients require rehabilitation and benefit from bracing for stability.

Conclusions: Left knee ligamentous injuries leading to Segond fracture brought about dysfunction in our patient. Inpatient rehabilitation significantly improved his ambulation and function.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-segond-opportunity-to-walk-a-case-of-polytrauma-with-segond-fracture/