4. fractures in acute knee injuries

8/19/2019 4. Fractures in Acute Knee Injuries

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Fig. 1: AP radiograph (A) showing a Segond fracture (arrow). Sagittal (B) andcoronal (C) Proton Density Fat Suppressed (PDFS) MRI showing wavy torn ACL

(arrow heads), partial MCL tear (yellow arrow) and the Segond fracture (whitearrow)

A B C


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Fig. 2: AP (A) and lateral (B) radiographs showing an avulsion fracture (arrows) of thetip of the fibular styloid process (arcuate fracture). Not the Salter-Harris type II fracture

of the proximal tibia (open arrow).

A A


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Fig. 3: Coronal and Sagittal PDFS MRI of the same knee in Fig. 2, demonstrating thearcuate fracture (arrows)


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Fig. 4: AP and lateral knee radiographs (A and B) , coronal PDFS (B), sagittal PD MRI(C) demonstrating an avulsion fracture at the tibial attachment of the ACL (arrows).

Note the Segond fracture (open arrow)

A

C D

B


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Fig. 5: AP and lateral knee radiographs of the knee demonstrating a triangular bonyfragment at the posterior aspect of the intercondylar eminence, consistent of a PCL

avulsion fracture


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Fig. 6: Sagittal CT (A), sagittal PD (B) and coronal PDFS (C) MRI demonstrating thePCL avulsion fracture at its tibial attachment with fracture lines extending further on

either sides of the avulsion site

C A B


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FRACTURES ASSOCIATED WITH

PATELLAR DISLOCATION

Mechanism of patellar dislocation: Usually valgus

stress to the flexed, internally rotated knee on aplanted foot


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Fig. 7: Irregular bony fragment lateral to the patella. This appearance should raise thesuspicion of a recent transient patellar dislocation


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Fig. 8: MRI of the same knee in Fig.7. Axial PD (A and B) and coronal PDFS (C)demonstrating a large displaced patellar osteochondral fracture fragment (arrow

heads) with a defect at the lateral patellar facet (arrows). Sagittal PDFS images (Dand E) demonstrating edema at the lateral femoral condyle and medial aspect of the

patella consistent with transient lateral patellar dislocation

B A C

D E


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Fig. 9: AP and lateral knee radiographs showing subtle bony irregularity at themedial femoral condyle with underlying sclerosis consistent with an osteochondral

lesion. Bony irregularity at the articular surface of the patella suspicious of anosteochondral lesion


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Fig. 10: Coronal and sagittal PDFS (A and B) demonstrating the osteochondrallesion (arrow) on the radiograph (Fig. 9). Sagittal PDFS (C) confirming a patellar

osteochondral lesion (arrow)

A B C


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Fig. 11: Avulsion fracture fragment atthe inferior pole of the patella on a

lateral knee radiograph


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Patellar fracturesecondary to transient

dislocation

SegondOCL

Arcuate ACL/ PCL

avulsion


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ACL avulsion

Patellar sleeve

Arcuate

PCL avulsion


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4. fractures in acute knee injuries

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