1. Centro Hospitalar de Setúbal - Hospital Ortopédico de Santíago do Outão, Setúbal, Portugal
2. Centro Hospitalar do Barreiro-Montijo, Barreiro, Portugal
3. Hospital de Vila Franca de Xira, Vila Franca De Xira, Portugal
4. Centro Hospitalar Lisboa Central - Hospital Curry Cabral, Lisboa, Portugal
5. Centro Hospitalar Lisboa Central - Hospital Dona Estefânia, Lisboa, Portugal
- Poster, Congresso Europeu de Ortopedia, Viena, 29 de Maio a 1 de Junho de 2017
Background: The Segond fracture is a lateral knee injury and is associated with other lesions, such as ACL rupture (partial or complete) in the majority of the cases (75-100%). It is a rare condition in children and adolescents and in these cases it is usually associated with avulsion of the tibial spines, being rare the intrasubstance rupture of the Anterior Cruciate ligament (ACL).
Case Presentation: The authors present a case of a 14-year-old girl who suffered an accident after falling when she was doing parkour, resulting in knee trauma. She was taken to the emergency department of our institution and the observation showed knee edema and difficult in bearing weight and mobilizing the knee. The performed radiograph showed a lesion possibly compatible with a Segond fracture. A knee Magnetic Resonance Imaging (MRI) was performed and confirmed the presence of a partial rupture of the ACL. Surgical treatment was decided with arthroscopic surgery. Partial ACL rupture was observed. There was the need to convert to open surgery and, at this time, was observed lateral colateral ligament (LCL) avulsion on the lateral face of the external tibial plateau. It was decided to fixate the LCL avulsion with suture anchor. At the end of the surgery, there was a slight antero-posterior ligamentar instability (but increased stability in respect to initial examination), and conservative treatment was decided in relation to the partial rupture of the ACL.
Outcomes: After the surgery, the patient had indication for non weightbearing and knee orthosis blocked in extension and with varus-valgus block. Initiated range of motion at 2 weeks, initially limited to 30o for 2 weeks, then increased to 60o and started 0-90o at 6 weeks. In this phase also started protected progressive weight bearing. There was a fracture consolidation and at the 6-month follow-up visit there was slight anteroposterior instability with positive anterior drawer sign, without lateral instability and negative meniscal tests.
Discussion: This type of fracture is rare in our clinical practice and is therefore an interesting case. The decision by surgical treatment was made by the presence of a great antero-posterior and lateral instability. Although the fracture itself is small, the extensive ligamentous injury associated with it usually requires surgical intervention. After fracture fixation, the stability was again tested, showing an increase in stability, despite the partial rupture of the ACL. The need to convert from arthroscopic surgery to open surgery is due to the fact that we may not see this type of lesions, because of their rarity. The risk of not treating this type of injury is essentially the chronic instability of the knee, mainly the rotational instability.
Palavras-chave: Segond Fracture, ACL Rupture, Arthroscopy, Suture Anchors