CASE 13865 Published on 23.08.2016

Distal femoral fracture Muller Type B1 associated with Segond fracture


Musculoskeletal system

Case Type

Clinical Cases


Asma Jatoi1, Samar Hamid1, Shazia Kadri2, Tariq Mahmood3

1. Postgraduate Resident FCPS (II)
2. Consultant Radiologist
3. Head of department
Department of Radiology
Jinnah Postgraduate Medical Center
Karachi, Pakistan

24 years, male

Area of Interest Bones ; No Imaging Technique
Clinical History
A 24-year-old male patient presented to us with severe right knee joint pain and restricted movements. He had had a road traffic accident four months before after which he refused any surgical intervention. He eventually came back to us in severe pain.
Imaging Findings
Plain radiographs show intra-articular oblique fracture traversing the lateral femoral condyle with its marked upward displacement. Distal end of femur is medially displaced with reduced joint space at lateral compartment. (Fig. 1, 2, 3)
Initial AP radiograph shows possible avulsion of lateral tibial plateau. Slightly angulated radiograph demonstrates classical Segond fracture. (Fig. 2)
MRI performed on 1.5 Tesla Philips scanner shows displaced oblique fracture of lateral femoral condyle extending from metaphysis up to the articular surface. According to Muller classification, it represents Type B1 fracture (sagittal, lateral condyle). (Fig. 4, 8)
Classical chipped off curvilinear bone fragment seen parallel to lateral tibial plateau representing Segond fracture. (Fig. 5).
Non-visualization of anterior cruciate ligament (ACL) noticed along with buckling of posterior cruciate ligament representing complete tear of ACL. (Fig. 6)
Complex tear of anterior horn and body of lateral meniscus is seen. (Fig. 7, 8)
STIR shows bone bruise at the fractured lateral femoral condyle. (Fig. 9).
Distal femoral fracture involving condyle of femur results from high and low energy injuries in young and elder patients respectively. A wide spectrum of associated soft tissue injuries are a common finding. [1]

Clinical perspective

Patients usually present with sudden, immense and sharp pain with weight bearing immediately after the injury followed by restricted movement. Later on swelling and bruising occur around the injury site. On examination, one can look for deformities, swelling, contusion or protruding bone through the skin. These fractures may be complicated by osteomyelitis, neurovascular damage, delayed consolidation / nonunion, compartment syndrome and septic arthritis. [2]

Imaging perspective

Conventional radiographs are the first line of investigation. CT is utilized in high grade injuries to assess intra-articular involvement and fracture fragments. [3] MRI is essential in all cases of intra-articular fractures to identify internal joint derangement. [4] There is a selective role of arteriography in some cases based on the history or clinical findings of ischaemia to map vascular injury, which has an incidence of around 37% in injuries involving the knee joint. [7]

Muller AO classification is the most widely used system for classifying distal femoral fractures. It was first published in 1987 by the AO Foundation as a method of categorizing injuries according to their localization and severity. Muller classification divides distal femoral fractures into 3 types, according to the localization of the fracture. [6]

Type A fractures : Extra-articular
Type B fractures : Partial articular
Type C fractures : Complete articular fractures with detachment of both condyles from the diaphysis.

These fracture types are further subdivided describing the degree of fragmentation and other, more detailed characteristics.

Fracture Type B is divided into:
B1 (sagittal, lateral condyle)
B2 (sagittal, medial condyle)
B3 (frontal, Hoffa type).

Fracture Type C is divided into:
C1 (articular simple, metaphyseal simple)
C2 (articular simple, metaphyseal multifragmentary)
C3 (multifragmentary). [5]


Distal femoral fractures especially involving the condyles require surgery and a post-op brace to limit the range of motion. Surgical intervention includes open reduction and internal fixation using hardware to stabilize the fractured bone. A majority of fractures heal within the following 4 to 6 months, depending on the severity of the injury. When properly treated and rehabilitated most of the patients regain their full strength and range of motion in the injured leg. [4]. Our patient was also treated surgically with good outcome and minimum postoperative morbidity.

Take home massage
Distal femoral fractures need comprehensive radiological imaging to search for associated soft tissue injuries in addition to bone trauma. This provides a comprehensive road map to the orthopaedic surgeon.
Differential Diagnosis List
Muller Type B1 (sagittal, lateral condyle) distal femoral fracture with associated Segond fracture
Tibial plateau fracture
Complete intraarticular fracture of femoral condyle
Final Diagnosis
Muller Type B1 (sagittal, lateral condyle) distal femoral fracture with associated Segond fracture
Case information
DOI: 10.1594/EURORAD/CASE.13865
ISSN: 1563-4086