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The "Reverse Segond" Fracture

Association with a Tear of the Posterior Cruciate Ligament and Medial Meniscus

Eva M. Escobedo1, William J. Mills2 and John C. Hunter1

1 Department of Radiology, University of Washington Harborview Medical Center, 325 Ninth Ave., Seattle, WA 98104-2499.
2 Department of Orthopaedics, University of Washington Harborview Medical Center, Seattle, WA 98104-2499.



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  		Fig. 1A. —29-year-old man involved in pedestrian-versus-automobile collision. Anteroposterior (A) and close-up anteroposterior (B) radiographs of knee show small avulsion fragment (white arrow) off medial aspect of tibial plateau. Bone fragment adjacent to tibial eminence represents posterior cruciate ligament avulsion (black arrow).

 


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  		Fig. 1B. —29-year-old man involved in pedestrian-versus-automobile collision. Anteroposterior (A) and close-up anteroposterior (B) radiographs of knee show small avulsion fragment (white arrow) off medial aspect of tibial plateau. Bone fragment adjacent to tibial eminence represents posterior cruciate ligament avulsion (black arrow).

 


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  		Fig. 2A. —36-year-old woman involved in pedestrian-versus-automobile collision. Anteroposterior (A) and close-up of anteroposterior (B) radiographs of knee shows small avulsion fragment (arrow) off medial aspect of tibial plateau.

 


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  		Fig. 2B. —36-year-old woman involved in pedestrian-versus-automobile collision. Anteroposterior (A) and close-up of anteroposterior (B) radiographs of knee shows small avulsion fragment (arrow) off medial aspect of tibial plateau.

 


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  		Fig. 3A. —52-year-old woman involved in high-energy motor vehicle collision. Anteroposterior intraoperative fluoroscopic spot film of knee shows small avulsion fragment (arrow) adjacent to medial joint line and evidence of cortical disruption (arrowhead) of medial tibia.

 


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  		Fig. 3C. —52-year-old woman involved in high-energy motor vehicle collision. Anteroposterior radiograph of knee 6 months after trauma shows avulsion fragment (white arrow), now well corticated. Black arrow shows medial tibial bony defect.

 


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  		Fig. 1C. —29-year-old man involved in pedestrian-versus-automobile collision. Coronal reformation of CT scan shows deep medial collateral ligament avulsion fragment (white arrow) and resultant cortical defect (black arrow).

 


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  		Fig. 1D. —29-year-old man involved in pedestrian-versus-automobile collision. Sagittal reformation of CT scan shows avulsion fracture fragments (black arrows) of proximal attachment of posterior cruciate ligament. More superior fragment remains attached to posterior cruciate ligament (white arrows).

 


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  		Fig. 2C. —36-year-old woman involved in pedestrian-versus-automobile collision. Proton density—weighted fast spin-echo coronal MR image of knee shows bony avulsion (arrowhead) of deep medial collateral ligament with cortical defect (small arrow). Large arrow shows peripheral tear of medial meniscus.

 


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  		Fig. 2D. —36-year-old woman involved in pedestrian-versus-automobile collision. T2-weighted fat-suppressed fast spin-echo sagittal MR image of knee shows avulsion (arrow) of proximal posterior cruciate ligament.

 


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  		Fig. 3B. —52-year-old woman involved in high-energy motor vehicle collision. Proton density—weighted fast spin-echo sagittal MR image shows disruption of posterior cruciate ligament. Note coronal position of tibia that results from significant ligamentous instability. Distal end of posterior cruciate ligament (long white arrow) is intact, but entire proximal portion (short white arrows) is disrupted. Disruption (black arrows) of superficial medial collateral ligament is shown. Deep medial collateral ligament (arrowhead) is also torn.

 

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