Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents following a high-energy rotational injury to the knee. Reports immediate onset of lateral knee pain, audible "pop," and subsequent joint instability. Mechanism consistent with forced internal rotation and varus stress. Notable hemarthrosis and difficulty with weight-bearing.
Clinical Examination Findings
Physical exam reveals significant lateral joint line tenderness and localized swelling. Positive pivot-shift test and positive Lachman test, suggesting concomitant ACL injury. Lateral collateral ligament (LCL) stability should be assessed. Radiographic imaging confirms an avulsion fracture of the lateral tibial plateau (Segond fracture).
Treatment Protocol
Initial management includes RICE protocol (Rest, Ice, Compression, Elevation) and non-weight bearing with crutches. Immobilization in a hinged knee brace locked in extension. Surgical consultation is mandatory due to the high association with ACL rupture and potential knee instability. Surgical fixation of the avulsion fragment may be indicated if displacement is significant.