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Updated: May 12, 2026

In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy
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Distal tibiofibular radiological overlap: Does it always exist?

B Sowman1, R Radic, M Kuster

  • 1Royal Perth Hospital, Department of Orthopaedic Surgery, 197 Wellington Street, Perth, Western Australia 6000, Australia.

Bone & Joint Research
|April 24, 2013
PubMed
Summary
This summary is machine-generated.

The distal tibiofibular overlap is not always present in adults, challenging the assumption that its absence indicates syndesmotic injury. This study suggests that a lack of overlap can be a normal variant in a small proportion of the population.

Keywords:
AnkleDiastasisFractured ankleMedial clear spaceSyndesmosisTibiofibular overlap

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Area of Science:

  • Orthopedic surgery
  • Radiology
  • Anatomy

Background:

  • The distal tibiofibular overlap is traditionally considered positive.
  • Absence of this overlap is often indicative of syndesmotic injury.

Purpose of the Study:

  • To investigate the prevalence of distal tibiofibular overlap in the adult population.
  • To test the hypothesis that a lack of overlap is a normal anatomical variant.

Main Methods:

  • Analysis of axial CT scans of the ankle in 325 adult patients.
  • Image reconstruction to simulate plain film radiographs for multiplanar assessment.
  • Correlation of findings with patient history of injury, trauma, surgery, or pain.

Main Results:

  • No distal tibiofibular overlap was observed in four out of 325 patients.
  • These patients were further evaluated to rule out underlying ankle pathology.

Conclusions:

  • The absence of distal tibiofibular overlap can occur in a small percentage of the adult population.
  • This finding suggests that a lack of overlap may represent a normal variant, not necessarily indicative of syndesmotic injury.