Avulsion Fracture of the Head of the Fibula (the "Arcuate" Sign): MR Imaging Findings Predictive of Injuries to the Posterolateral Ligaments and Posterior Cruciate Ligament
Guo-Shu Huang1,
Joseph S. Yu2,
Muhammad Munshi3,
Wing P. Chan4,
Chian-Her Lee5,
Cheng-Yu Chen1 and
Donald Resnick3
1 Department of Radiology, Tri-Service General Hospital, National Defense
Medical Center, No. 325, Section 2, Cheng-Kung Rd., Neihu, Taipei 114, Taiwan,
Republic of China.
2 Department of Radiology, Ohio State University Medical Center, S-207 Rhodes
Hall, 450 W. Tenth Ave., Columbus, OH 43210.
3 Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla
Village Dr., San Diego, CA 92161.
4 Department of Radiology, Taipei Medical University-Municipal Wan Fang
Hospital, 111 Hsing-Long Rd., Section 3, Taipei 116, Taiwan, Republic of
China.
5 Department of Orthopedic Surgery, Tri-Service General Hospital, National
Defense Medical Center, Taipei 114, Taiwan, Republic of China.
View larger version (86K):
[in a new window]
|
Fig. 1A. —23-year-old man with acute posterolateral instability of left
knee after motor vehicle collision. Anteroposterior (A) and lateral
(B) radiographs reveal avulsion fracture of styloid process of fibular
head (long arrow) and posterior cruciate ligament avulsion fracture
at posterior tibial plateau (short arrow).
|
|
View larger version (108K):
[in a new window]
|
Fig. 2A. —25-year-old man with chronic posterolateral instability of
right knee after motor vehicle collision. Anteroposterior (A) and
lateral (B) radiographs reveal avulsed bone fragment of fibular styloid
process (arrow). Transverse orientation and posterior location of
avulsed bone fragment differ from that of Segond fracture.
|
|
View larger version (97K):
[in a new window]
|
Fig. 3A. —21-year-old man with chronic posterolateral instability of
right knee after motor vehicle collision. Anteroposterior radiograph reveals
avulsed bone fragment of fibular styloid process (arrow).
|
|
View larger version (69K):
[in a new window]
|
Fig. 4A. —22-year-old man with acute posterolateral instability of left
knee after motor vechicle collision. Anteroposterior radiograph shows avulsion
fracture of styloid process of fibular head with superior displacement and
tilting of bone fragment (arrow).
|
|
View larger version (97K):
[in a new window]
|
Fig. 1B. —23-year-old man with acute posterolateral instability of left
knee after motor vehicle collision. Anteroposterior (A) and lateral
(B) radiographs reveal avulsion fracture of styloid process of fibular
head (long arrow) and posterior cruciate ligament avulsion fracture
at posterior tibial plateau (short arrow).
|
|
View larger version (105K):
[in a new window]
|
Fig. 2B. —25-year-old man with chronic posterolateral instability of
right knee after motor vehicle collision. Anteroposterior (A) and
lateral (B) radiographs reveal avulsed bone fragment of fibular styloid
process (arrow). Transverse orientation and posterior location of
avulsed bone fragment differ from that of Segond fracture.
|
|
View larger version (126K):
[in a new window]
|
Fig. 1C. —23-year-old man with acute posterolateral instability of left
knee after motor vehicle collision. Sagittal spin-echo proton
density—weighted image (TR/TE, 1800/20) (C) and coronal short tau
inversion recovery (STIR) image (D) (3000/40; inversion time, 100 msec)
reveal avulsed bone fragment (long arrow) with marrow edema in
corresponding site of attachment of popliteofibular ligament adjacent to
popliteal tendon (arrowhead, C). Note avulsion fracture of
posterior tibial plateau at attachment of posterior cruciate ligament
(short arrow, D) in coronal STIR image.
|
|
View larger version (129K):
[in a new window]
|
Fig. 1D. —23-year-old man with acute posterolateral instability of left
knee after motor vehicle collision. Sagittal spin-echo proton
density—weighted image (TR/TE, 1800/20) (C) and coronal short tau
inversion recovery (STIR) image (D) (3000/40; inversion time, 100 msec)
reveal avulsed bone fragment (long arrow) with marrow edema in
corresponding site of attachment of popliteofibular ligament adjacent to
popliteal tendon (arrowhead, C). Note avulsion fracture of
posterior tibial plateau at attachment of posterior cruciate ligament
(short arrow, D) in coronal STIR image.
|
|
View larger version (123K):
[in a new window]
|
Fig. 2C. —25-year-old man with chronic posterolateral instability of
right knee after motor vehicle collision. Sagittal spin-echo proton
density—weighted MR image (TR/TE, 1800/20) reveals avulsed osseous
fragment of styloid process of fibular head (arrow) adjacent to
popliteal tendon (arrowhead).
|
|
View larger version (129K):
[in a new window]
|
Fig. 3B. —21-year-old man with chronic posterolateral instability of
right knee after motor vehicle collision. Sagittal spin-echo proton
density—weighted MR image (TR/TE, 1800/20) reveals avulsed osseous
fragment (arrow) adjacent to popliteal tendon
(arrowhead).
|
|
View larger version (158K):
[in a new window]
|
Fig. 3C. —21-year-old man with chronic posterolateral instability of
right knee after motor vehicle collision. Coronal spin-echo proton
density—weighted MR image (1800/20) reveals disruption of lateral
collateral ligament (arrowhead) and avulsed osseous fragment
(arrow) in corresponding course of popliteofibular ligament.
|
|
View larger version (90K):
[in a new window]
|
Fig. 4B. —22-year-old man with acute posterolateral instability of left
knee after motor vechicle collision. Sagittal spin-echo T2-weighted MR image
(TR/TE, 1800/80) reveals edema in fibular head (arrow) and soft
tissues around popliteal tendon (arrowhead) and arcuate complex in
posterolateral corner. Bone fragment is not well depicted.
|
|
View larger version (138K):
[in a new window]
|
Fig. 4C. —22-year-old man with acute posterolateral instability of left
knee after motor vechicle collision. Coronal spin-echo proton
density—weighted MR image (1800/20) reveals disruption of lateral
collateral ligament (arrowhead) and edema in surrounding tissues.
Note tear of posterior cruciate ligament (arrow).
|
|
View larger version (122K):
[in a new window]
|
Fig. 2D. —25-year-old man with chronic posterolateral instability of
right knee after motor vehicle collision. Sagittal spin-echo proton
density—weighted MR image (1800/20) obtained medial to C reveals
disruption of posterior cruciate ligament (arrow).
|
|
View larger version (134K):
[in a new window]
|
Fig. 3D. —21-year-old man with chronic posterolateral instability of
right knee after motor vehicle collision. Sagittal spin-echo proton
density—weighted MR image (1800/20) obtained medial to B reveals
tear of posterior cruciate ligament (arrow).
|
|
View larger version (151K):
[in a new window]
|
Fig. 1E. —23-year-old man with acute posterolateral instability of left
knee after motor vehicle collision. Coronal STIR image (3000/40; inversion
time, 100 msec) obtained posterior to D reveals tear of popliteal
tendon (arrowheads) at musculotendinous junction with hemorrhage and
edema in popliteal muscle and surrounding tissues.
|
|
View larger version (11K):
[in a new window]
|
Fig. 5. —Diagram of posterior aspect of fibula shows insertions of
ligaments and tendons in fibula. Popliteofibular ligament inserts in upper
facet of apex of fibular head, just medial to insertions of fabellofibular and
arcuate ligaments. Lateral collateral ligament and direct arm of tendon of
long head of biceps femoris muscle (dlB) are attached to lateral margin of
fibular head.
|
|
View larger version (14K):
[in a new window]
|
Fig. 6. —Cross-sectional diagram through proximal tibia and fibula
shows insertions of ligaments and tendons in fibula. Direct arm of tendon of
long head of biceps femoris muscle (dlB) is attached to lateral margin of
fibular head. Direct arm of tendon attaches to fibular head just lateral and
posterior to attachment site of lateral collateral ligament. Fabellofibular
and arcuate ligaments insert in apex of fibular head (fibular styloid
process). Attachment of fabellofibular ligament is just superficial to that of
arcuate ligament. Popliteofibular ligament inserts in upper facet of apex of
fibular head, just medial and posterior to insertions of arcuate and
fabellofibular ligaments.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2003 by the American Roentgen Ray Society.
