Fibular head avulsion fractures are rare and are so-called the arcuate signal. Avulsion fracture of the iliotibial band and anterolateral ligament is known as a Segond fracture, and it is another rare entity. We describe the case of a 27-year-old woman who was hit by a car and suffered polytrauma, mainly suffering injuries to both knees. Radiographs of the knees showed a Segond fracture associated with the arched signal bilaterally. The aim of this study is to present a rare case report and literature review of a bilateral fibular head avulsion fracture associated with an anterolateral tibial avulsion fracture.

RESUMOObjetivos: Verificar o valor da artroscopia na investigação e no tratamento da dor no joelho pós-artroplastia não esclarecida por exames clínicos e subsidiários. Métodos: Entre 402 pacientes submetidos à artroplastia total ou unicompartimental de setembro de 2001 a abril de 2007 num hospital universitário público, 17 deles apresentavam dor na articulação protética, sem diagnóstico clínico, radiográfico, laboratorial, cintilográfico ou por ressonância nuclear magnética. Todos foram submetidos à artroscopia e a sintomatologia foi avaliada pela escala de Lysholm, comparando-se os períodos pré e pós-artros copia. Os achados intraoperatórios foram registrados. Resultados: O procedimento foi eficaz para alívio do sintoma doloroso em 14 dos 17 pacientes (82,35%). A mediana do escore de Lysholm subiu de 36 pontos antes da artroscopia para 94 pontos após (p < 0,001). A maioria dos pacientes (12) apresentava como diagnóstico artroscópico um quadro de fibrose conhecido como "ciclope"; nos outros cinco pacientes foi verificada sinovite anterior. Todos foram tratados com ressecção. Conclusões: A artroscopia do joelho pós-artroplastia em pacientes com dor persistente a diagnosticar revela quadros de artrofibrose localizada ("ciclopes") ou de sinovite, que podem ser tratados pelo mesmo procedimento, resultando em melhora do quadro álgico. Descritores

Objectives: Assess the worthiness of arthroscopy in investigating and treating knee pain after arthroplasty unexplained by clinical and subsidiary examinations. Methods: Among 402 patients submitted to total or unicompartimental arthroplasty between September 2001 and April 2007 at a public university hospital, 17 presented with pain on prosthetic articulation, without clear diagnosis by clinical, X-ray, laboratory, scintiscan, or nuclear magnetic resonance tests. All patients were submitted to arthroscopy and symptoms were assessed by using the Lysholm scale, comparing pre-and post-arthroscopy periods. Peroperative findings have been recorded. Results: The procedure was effective for pain relief in 14 of 17 patients (82.35%). The median for Lysholm scale climbed from 36 points before arthroscopy to 94 points after the procedure (p < 0.001). Most of the patients (12) were arthroscopically diagnosed with fibrosis known as “cyclop”; on the remaining five patients, anterior synovitis was found. All patients were treated by resection. Conclusions: Knee arthroscopy after arthroplasty in patients presenting unclear persistent pain shows localized arthrofibrosis (“cyclops”) or synovitis, which can be treated by using the same procedure, resulting in pain relief.