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Related Concept Videos

Ankle Joint01:10

Ankle Joint

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The ankle is formed by the talocrural joint (crural = leg). It consists of the articulations between the talus bone of the foot and the distal ends of the tibia and fibula of the leg. The superior aspect of the talus bone is square-shaped and has three areas of articulation. The top of the talus articulates with the inferior tibia. This is the portion of the ankle joint that carries the body weight between the leg and foot. The sides of the talus are firmly held in position by the articulations...
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Bones of the Lower Limb: Tibia and Fibula01:10

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The tibia is the main weight-bearing bone of the lower leg. It is larger than the fibula with which it is paired. The tibia is also the second longest bone in the body and is located right below the skin. The proximal end of the tibia forms the medial and the lateral condyle, which articulates with the condyles of the femur to form the knee joint. Between the articulating surfaces is the irregular elevated area known as the intercondylar eminence that serves as the inferior attachment point for...
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Related Experiment Video

Updated: Jul 5, 2025

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Image Rotation Alters Apparent Fibula Length: An Evaluation of Talocrural Angle, Shenton Line, and Dime Sign.

Nicholas J Jackson1, Kevin T Root2, Jennifer A Nichols1,3

  • 1J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.

Foot & Ankle International
|January 19, 2024
PubMed
Summary

Fibula length assessment on ankle radiographs is challenging due to limb positioning. Sagittal plane rotation significantly alters the talocrural angle (TCA), potentially masking fibula shortening and impacting diagnostic accuracy.

Keywords:
anklemalreductionradiographssurgerytrauma

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Area of Science:

  • Orthopedic imaging
  • Radiographic analysis
  • Lower extremity biomechanics

Background:

  • Fibula shortening can negatively affect ankle stability and clinical outcomes.
  • Accurate radiographic assessment of fibula length is difficult due to the 2D representation of 3D anatomy.
  • The talocrural angle (TCA), Shenton line, and dime sign are key radiographic indicators of fibula length.

Purpose of the Study:

  • To investigate the impact of 3D limb positioning on radiographic parameters used to assess fibula length.
  • To quantify the effect of sagittal and axial plane rotations on the talocrural angle (TCA).
  • To evaluate the influence of these rotations on the reliability of fibula length assessment.

Main Methods:

  • 3D bone models were created from CT scans of 30 lower limbs.
  • Digital radiographs were generated with controlled fibula length and 1-degree increments of limb rotation.
  • The talocrural angle (TCA) was measured, and the Shenton line and dime sign were assessed by observers.

Main Results:

  • Sagittal plane rotation significantly altered the TCA, with approximately 1 degree change per millimeter of fibula length variation.
  • Caudal rotation could obscure 2mm of fibular shortening, creating a false positive for normal length.
  • Observer accuracy in identifying true mortise views was significantly reduced on false positive images, with poor interobserver agreement.

Conclusions:

  • Sagittal plane rotation is a critical factor affecting the radiographic appearance of fibula length, particularly the TCA.
  • Axial rotation has a minimal impact on these measurements.
  • Further research is needed to understand the effect of rotation on the Shenton line and dime sign perception.