Easily Missed

Injuries around the

Knee
Radiographics 1994; 14: 1191-1210

R 劉志
強
 Introduction
• Injuries to proximal tibia
– Tibial plateau fx, Segond fx, Tibial spine fx,
Cancellous stress fx
• Injuries to fibular head and tibiofibular joint
– Tibiofibular joint dislocation, Fibular head fx
• Injuries to patella
– Patellar fx, osteochondral injuries
• Injuries to patellar and quadriceps tendon
• Injuries to distal femur
– Femoral condyle fx, Osteochondral fx,
• Salter-Harris type fx
 Tibial Plateau Fx
• Minimally depressed tibial plateau fx, defined as
those with displacement or depression of less
than 4mm
 Tibial Plateau Fx
• Fx no seen on AP or lat view may sometimes be
visualized on tangential or tunnel view
• Should be evaluated with CT for determining the
extent of articular surface involvement,
establishing the location of fracture fragments
 Segond Fx
• The Segond fx is a small vertical avulsion
of the proximal lateral tibia immediately
distal to the tibial plateau.
• Precipitating injury usu. involves internal
rotation associated with varus stress
• Fx fragment is usu. Elliptical and 10X3mm
in size, and about 3mm displacement from
tibial metaphysis
Segond Fx
 Segond Fx
• Although minor appearing, associated with a
high incidence of coexisting ACL and meniscal
injuries
 Tibial Spine Fx
• Result from either torsional forces about the
knee or hyperflexion or hyperextension forces
causing avulsion of the intercondylar eminence
or the attachments of the cruciate ligaments
• one of most common knee injuries in children;
most common between ages of 8-14 yrs
• commonly caused by fall
from bicycle or motorcycle
Tibial Spine Fx
• Categorized into 4 types
 Stress Fx
• The proximal tibia is the most common
stress fx about the knee
• On plain radiographs, a vague band of
increased sclerosis or endosteal callus
may be visualized
 Stress Fx

Initial imaging was unremarkable, MR image 10

days later shows an irregular horizontal band of low
signal intensity surrounded by bone marrow edema
Proximal Tibiofibular joint Dislocation
• Estimated 60% of all cases are
unrecognized at initial presentation
• 4 types have been described
• Making the correct diagnosis usu. requires
clinical suspicion
• A well positioned lateral radioraph is the
most useful projection
Proximal Tibiofibular joint Dislocation
Mild widening of the interosseous space on the left
Lateral film demostrates incongruity of the proximal
tibiofibular joint -----> Ant Lat dislocation
 Fibular Head Fx
• Results from injury
producing excessive varus
stress about the knee
• Peroneal nerve and anterior
tibial artery may be injured
• Lateral capsular and
ligamentous disruption and
peroneal nerve – Lateral
compartment syndrome of
the knee / Ligamentous
peroneal nerve syndrome
 Patellar Fx
• May be classified as stellate or
comminuted; longitudinal or marginal;
transverse, proximal or distal pole
 Patellar Tendon Injury
• Clinical presentation is usu. diagnostic
• A soft tissue opacity due to hematoma or
hemorrhage can be seen in the region of
patellar tendon on lateral radiograph
• A high riding patella, or patella alta can be
seen
• Patella position may appear normal with
knee in full extension
Patellar Tendon Injury
 Quadriceps Tendon Injury
• Rupture of the quadriceps tendon tends to
occur in older population
• The normally sharp fat planes are
obscured by hemorrhage and hematoma
• A low riding patella, or patella baja may be
seen
 Quadriceps Tendon Injury

Note How the Patella is Abnormally Tilted and

Positioned on the right compared to the left
 Femoral Condyle Fx
• Usually occur as a result of varus or
valgus stress along with axial loading
forces
• With associated tibial plateau fx
• Isolated fx of the femoral condyles are
uncommon
• Fractures are often Y or T shaped,
extending into intercondylar notch and are
both intraarticular and intracapsular
 Femoral Condyle Fx

Non displaced lateral femoral condyle fracture

 Osteochondral fracture
• The cartilage covering the end of a bone
in a joint (articular cartilage) is torn
• The fracture creates bone or cartilage
fragments that can range in size and in
depth
• Frequently found on the weight bearing
surfaces of the femur, can also occur
under the patella
 Osteochondral fracture

Osteochondral fragment in the joint space

 Osteochondral fracture
• Osteochondral fx of the lateral femoral
condyle often accompany tears of the ACL
Salter-Harris Type Fracture
Conclusion