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Radiographic evaluation of the ankle syndesmosis
Stephen Croft1, Andrew Furey1, Craig Stone1
1The Department of Orthopaedic Surgery, Memorial University of Newfoundland, St. John's, Nfld.
Canadian Journal of Surgery. Journal Canadien De Chirurgie
|January 27, 2015
Summary
A new anterior tibiofibular ratio on lateral ankle radiographs reliably assesses syndesmotic stability. This simple measurement improves diagnosis of ankle injuries compared to other methods.
Area of Science:
- Orthopedic Surgery
- Radiology
- Anatomy
Background:
- Standard ankle radiography may inadequately document anatomy.
- Stress views and CT scans have limitations for assessing syndesmotic stability.
- A reliable orthogonal radiographic view is needed for dynamic and static evaluation.
Purpose of the Study:
- To identify a parameter on lateral ankle radiographs for reliable syndesmotic integrity diagnosis.
- To enhance the diagnostic capability of standard radiography for ankle syndesmosis.
Main Methods:
- Three orthopedic surgeons reviewed 80 lateral ankle radiographs.
- Radiographic rotation was assessed by talar dome overlap.
- Four parameters measured 1 cm above tibial plafond: fibular width, tibial width, anterior, and posterior tibiofibular intervals.
Main Results:
- 72 radiographs were deemed adequate for analysis.
- Interrater reliability ranged from moderate to near-perfect.
- The anterior tibiofibular ratio demonstrated strong to near-perfect reliability, indicating 40% of the tibia should be anterior to the fibula.
Conclusions:
- The anterior tibiofibular ratio offers an orthogonal measurement for syndesmotic assessment.
- This ratio can clinically and economically improve the diagnosis of syndesmotic disruptions.
- It complements existing parameters for evaluating ankle stability.
