Sagittal T2 FS MR image in the same patient shows a complete | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Sagittal T2 FS MR image in the same patient shows a complete disruption of the mid to proximal anterior cruciate ligament (ACL). This is the typical ligamentous injury associated with a Segond fracture (as seen on the prior MR image). The Segond fracture is classically due to avulsion of the tibial attachment of the lateral capsular ligament. As in this case, avulsion fractures may show little underlying marrow edema. True ligamentous disruption of the ACL is much more common in adolescent girls than boys. #FridayQuizDay

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Sagittal T2-W MRI shows the avulsion fracture (arrow) of the tibial spine and a large lipohemarthrosis (arrowhead). The lipohemarthrosis causes a parfait effect with blood layering most dependently (furthest from the arrowhead), effusion fluid in the middle, and fat floating on top. Tibial spine avulsion fractures are associated with anterior cruciate ligament (ACL) injuries. The ACL originates from the medial and anterior aspect of the tibial plateau and inserts on the lateral femoral condyle. Children are more likely to have tibial spine avulsions than an ACL rupture because the bone is weaker than the ligament. #FridayQuizDay #Quiz #FridayQuiz](https://app.figure1.com/case-detail/2b6863d3-50d3-44a1-889d-055553ac3d04)



AP radiograph (image 1) of the elbow show a small avulsion fracture (arrow) of the medial epicondyle. The coronal T1-W (image 2), and coronal T2-W (image 3) images show the avulsion fracture and disruption of the ulnar/medial collateral ligament. The medial/ulnar collateral ligament is most commonly injured in throwing athletes. However, it can also be injured in athletes who bear weight using the upper extremity (such as gymnasts and wrestlers). #MSKMonday](https://app.figure1.com/case-detail/325a82dd-ac9d-49eb-b788-41ba518d57d5)



Coronal (image 1), sagittal (image 2), and 3D reformatted (image 3) CT along with sagittal proton density MRI (image 4) highlight multiple injuries: an avulsion fracture (dashed arrow) of the lateral tibia epiphysis, an avulsion fracture of the tibial spine (arrow), and a large hemarthrosis (arrowhead). Both the fracture of the lateral tibia epiphysis and the tibial spine avulsion fracture are associated with ACL (orange arrow) rupture. The fracture of the lateral tibia epiphysis is termed a Segond fracture. In the majority of instances, Segond fractures are associated with ACL disruption. Thry occur as a result of internal rotation and varus stress. When the finding is made on radiograph, an MRI is typically indicated to assess for internal derangement of the knee. CT is not typically indicated. In this case, due to the extent of injury, CT was used to assess for loose bodies within the knee. The intact PCL (pink arrow) highlighted for comparison.](https://app.figure1.com/case-detail/3edf1d55-33a7-4cad-82b1-bc18cd16f3f6)



Sagittal T2 weighted MR of the knee in an adolescent shows disruption of the anterior cruciate ligament (arrow). ACL injuries typically occur when an athlete pivots and a valgus stress is applied to the knee in flexion. ACL injuries are more common in boys when the physis is not completely closed (as in this case). #MSKMonday](https://app.figure1.com/case-detail/3fa4a49c-f51d-403b-b194-94939213f74a)