25-year-old involved in motor vehicle accident

Case
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Evaluate for fracture or ACL tear. Motor vehicle accident. Pain lateral aspect. 

Long- and short-axis fat- and water-weighted images were performed. 

  • MARROW:
    • Diffuse marrow edema tibia. Diffuse marrow edema fibular head. Nondisplaced fibular fracture. Depressed fracture posterior tibial plateau with 3mm of depression. 
    • Plain films demonstrated Segond fracture 75% of the time associated with ACL tears. 
  • ACL/PCL:
    • Complete ACL rupture. 
    • Redundant-appearing PCL. Anterior translation of tibia on femur as additional finding. Fibular collateral ligament sprain and posterolateral corner tear involves rupture of popliteofibular ligament and arcuate sprain
  • MEDIAL  and  LATERAL MENISCI:
    • No evidence of a meniscal tear is seen. 
  • EXTENSOR MECHANISM:
    • Intact quadriceps and patellar tendons. 
  • PATELLOFEMORAL ARTICULATION:
    • Edematous patella likely secondary to direct contusion mechanism at the time of MVA. No displaced fracture identified. Intact patellofemoral cartilage. Marked streaky edema in Hoffa’s fat and shallow trochlear groove suggestive of patellofemoral maltracking. 
  • FEMOROTIBIAL ARTICULATION:
    • Intact cartilage both medial and lateral compartments. Anterolateral femoral edema associated with ACL rupture. 
  • NEUROVASCULAR BUNDLE:
    • Moderate-sized gastrocnemius-semimembranosus bursal cyst. Intact neurovascular bundle including popliteal artery and vein.

HYPEREXTENSION DISLOCATION MECHANISM OF INJURY WITH:

  • Slightly depressed posterior tibial fracture with extensive edema throughout the tibia. 
  • Review of plain films demonstrates Segond fracture classically associated as in this case with complete ACL rupture and lateral capsular/ corner injury. . 
  • Moderate-sized effusion with prominent microtrabecular injury anterolateral femur. 
  • Nondisplaced fibular head/neck fracture with extensive edema. 
  • Complete ACL rupture. Sprain base of PCL
  • No meniscal tear. 
  • Microtrabecular patellar fracture
  • Fibular collateral ligament sprain and posterolateral corner tear involves rupture of popliteofibular ligament and arcuate sprain.