Avulsion fracture of the head of the fibula (the "Arcuate" sign): MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament

被引:73
作者
Huang, GS
Yu, JS
Munshi, M
Chan, WP
Lee, CH
Chen, CY
Resnick, D
机构
[1] Triserv Gen Hosp, Dept Radiol, Natl Def Med Ctr, Taipei 114, Taiwan
[2] Ohio State Univ, Med Ctr, Dept Radiol, Columbus, OH 43210 USA
[3] Vet Adm Med Ctr, Dept Radiol, San Diego, CA 92161 USA
[4] Taipei Med Univ, Muncipal Wan Fang Hosp, Dept Radiol, Taipei 116, Taiwan
[5] Triserv Gen Hosp, Dept Orthoped Surg, Natl Def Med Ctr, Taipei 114, Taiwan
关键词
D O I
10.2214/ajr.180.2.1800381
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 [临床医学]; 100207 [影像医学与核医学]; 1009 [特种医学];
摘要
OBJECTIVE. The purpose of this study was to describe the significance of an avulsion fracture of the head of the fibula ("arcuate" sign) and its association with injuries of the knee on MR imaging. MATERIALS AND METHODS. We conducted a retrospective search of 2318 patients who underwent conventional radiography and MR imaging after an episode of knee trauma. Patients were included in this study if they had an avulsion fracture of the head of the fibula revealed on conventional radiography and underwent arthroscopy. Thirteen patients, all of whom were men, satisfied the inclusion criteria. Ten patients underwent further explorative surgery. The clinical, radiographic, MR imaging, and surgical findings were then reviewed. RESULTS. The avulsion fracture of the styloid process of the fibular head was apparently related to injuries of the arcuate complex in all 13 patients. Radiographically, the bony fragment was horizontally oriented and similar in size in most patients, ranging from 8 to 10 mm in length and from 2 to 5 mm in width. On MR imaging, the fibular avulsion was identified in 11 of the 13 patients. The other two patients had marrow edema in the fibular styloid process, although the avulsion fracture was not evident. All patients had injuries of the posterior cruciate ligament (six tibial avulsions, seven midsubstance tears). No patient had a tear of the anterior cruciate ligament. Disruption of the lateral collateral ligament was evident in seven patients, and one patient had a tear of the popliteal tendon. During surgery, six patients had disruption of the arcuate complex, but this disruption could not be identified on the MR images. CONCLUSION. An avulsion fracture of the fibular head generally involves the styloid process and causes injury of some of the major stabilizers in the posterolateral corner. Avulsion fractures are strongly associated with disruption of the posterior cruciate ligament.
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页码:381 / 387
页数:7
相关论文
共 18 条
[1]
ACUTE COMBINED POSTERIOR CRUCIATE AND POSTEROLATERAL INSTABILITY OF THE KNEE [J].
BAKER, CL ;
NORWOOD, LA ;
HUGHSTON, JC .
AMERICAN JOURNAL OF SPORTS MEDICINE, 1984, 12 (03) :204-208
[2]
Pathogenesis of the segond fracture: Anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion [J].
Campos, JC ;
Chung, CB ;
Lektrakul, N ;
Pedowitz, R ;
Trudell, D ;
Yu, J ;
Resnick, D .
RADIOLOGY, 2001, 219 (02) :381-386
[3]
EASILY MISSED INJURIES AROUND THE KNEE [J].
CAPPS, GW ;
HAYES, CW .
RADIOGRAPHICS, 1994, 14 (06) :1191-1210
[4]
ACUTE STRAIGHT LATERAL INSTABILITY OF THE KNEE [J].
DELEE, JC ;
RILEY, MB ;
ROCKWOOD, CA .
AMERICAN JOURNAL OF SPORTS MEDICINE, 1983, 11 (06) :404-411
[5]
POSTERIOR PROBLEMS IN THE KNEE - POSTERIOR CRUCIATE INSUFFICIENCY AND POSTEROLATERAL ROTATORY INSUFFICIENCY [J].
FLEMING, RE ;
BLATZ, DJ ;
MCCARROLL, JR .
AMERICAN JOURNAL OF SPORTS MEDICINE, 1981, 9 (02) :107-113
[6]
THE ROLE OF THE POSTEROLATERAL AND CRUCIATE LIGAMENTS IN THE STABILITY OF THE HUMAN KNEE - A BIOMECHANICAL STUDY [J].
GOLLEHON, DL ;
TORZILLI, PA ;
WARREN, RF .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1987, 69A (02) :233-242
[7]
CLASSIFICATION OF KNEE LIGAMENT INSTABILITIES .2. LATERAL COMPARTMENT [J].
HUGHSTON, JC ;
ANDREWS, JR ;
CROSS, MJ ;
MOSCHI, A .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1976, 58 (02) :173-179
[8]
MR evaluation of the "arcuate" sign of posterolateral knee instability [J].
Juhng, SK ;
Lee, JK ;
Choi, SS ;
Yoon, KH ;
Roh, BS ;
Won, JJ .
AMERICAN JOURNAL OF ROENTGENOLOGY, 2002, 178 (03) :583-588
[9]
LaPrade RF, 2001, POSTERIOR CRUCIATE LIGAMENT INJURIES, P23
[10]
RECONSTRUCTION OF THE CHRONICALLY INSUFFICIENT ANTERIOR CRUCIATE LIGAMENT WITH THE CENTRAL 3RD OF THE PATELLAR LIGAMENT [J].
OBRIEN, SJ ;
WARREN, RF ;
PAVLOV, H ;
PANARIELLO, R ;
WICKIEWICZ, TL .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1991, 73A (02) :278-286