Is this a fracture on the plain film?

There is this query which we all radiologists find in plain films in this era of MRIs and PETs and this section of ours is usually dealing with apparently innocuous questions like in this case “is this a fracture?” Professor Resident series by Dr MGK Murthy.

What is it?

There is vertical line across the metaphysis of 1st metatarsal with no significant soft tissue swelling or articular  abnormality

Is it fracture in view of history of injury ?

 No you can clearly see on invert image it is not identified and hence represents vessel

Any further imaging is needed?

No , we need to take radiological call  at this stage it is not fracture

 How to write  report?

There is vertical lucency seen across the middle of metaphysis of 1st Metatarsal  possibly representing  vessel with no soft tissue or joint involvement – represents vessel. However if there is local tenderness,  MRI / follow-up Xray after 2 weeks would help

Is it a segond's fracture?

Tibial plateau on lateral  aspect shows subtle ill definition and distal tibia below the plateau is unremarkable  with no definite avulsion fragment  away from the bone even on tunnel view (superior to AP view) and hence it is possibly normal gerdy tubercle and does not represent segond’s fracture, however, if clinically relevant  MRI would help exclude segond’s and associated injuries. Case submitted by –Dr MGK Murthy. 

 Teaching points 

Lateral tibial avulsion fracture is referred to as segonds fracture ( eponym being named after Dr Paul Segond).  Originally thought to be a result of avulsion of the medial third of the lateral collateral ligament, more recent research suggests that the insertion of the iliotibial tract (ITT) and the anterior oblique band (AOB), a ligamentous attachment of the fibular collateral ligament to the midportion of the lateral tibia, also play an important role. Associations   ACL tear(75 to 100%), any of the meniscus(66 to 70%), avulsion of the  fibular head  fracture, avulsion of gerdy tubercle. Avulsion fracture of medial collateral ligament associated with   PCL and medial meniscus injuries is referred to as reverse segond’s fracture