The pivot fracture: an unusual tibial plateau fracture found in association with acute ACL injury

Skeletal Radiol. 2022 Aug;51(8):1697-1705. doi: 10.1007/s00256-021-03962-x. Epub 2021 Dec 27.

Abstract

Tibial plateau fractures are common fractures which are often associated with concurrent soft tissue injury and for which accurate preoperative diagnosis is important for development of an appropriate treatment plan and outcome prediction. Here, we present an extreme manifestation of the pivot shift phenomenon with an unusual tibial plateau fracture with flipped component not described by any existing tibial plateau fracture classification system and never reported previously in conjunction with an anterior cruciate ligament injury. We describe the utilization of advanced imaging not typically utilized in the management of tibial plateau fractures in combination with clinical suspicion to diagnose the associated soft tissue injuries and develop an appropriate management plan.

Keywords: Anterior cruciate ligament rupture; Flipped fragment sign; Pivot shift injury; Tibial plateau fracture.

MeSH terms

  • Anterior Cruciate Ligament Injuries* / complications
  • Anterior Cruciate Ligament Injuries* / diagnostic imaging
  • Anterior Cruciate Ligament Injuries* / surgery
  • Humans
  • Soft Tissue Injuries* / complications
  • Soft Tissue Injuries* / diagnostic imaging
  • Tibia
  • Tibial Fractures* / complications
  • Tibial Fractures* / diagnostic imaging
  • Tibial Fractures* / surgery