Normal Tibiofibular Relationships at the Syndesmosis on Axial CT Imaging

Dikos, Gregory D.; Heisler, Jason; Choplin, Robert H.; Weber, Timothy G.

doi:10.1097/bot.0b013e3182535f30

Cited by 160 publications

(171 citation statements)

References 52 publications

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“…Measurements were documented 1 cm above the centre of the tibial plafond. 8,12 Ratios were determined in order to assess the positional relationship of the tibia relative to the fibula. …”

Section: Methodsmentioning

confidence: 99%

“…We have therefore described the anterior tibiofibular ratio (ATFR), which characterizes the ATFI:TW ratio described previously. It has been docu mented in the literature on a number of occasions that sagittal movement of the fibula relative to the tibia can represent a syndesmotic injury; 2,7,9,12,[16][17][18][19] however, to our knowledge only 2 studies 12,19 have attempted to determine specific criteria for diagnosis on the lateral view. In 2013, Grenier and colleagues 19 concluded that the tibiofibular joint can be accurately assessed on the lateral view when looking at the sagittal relationship of the tibia and the fibula.…”

Section: -11mentioning

confidence: 99%

“…Although they were able to use the physeal scar as a radiographic marker for measurement, we believe it to be an indistinct landmark that could introduce inconsistency. 19 In 2012, Dikos and colleagues 12 determined that the interval of the anterior fibula to the anterior tibia is a reliable marker based on comparison with axial CT images. In addition, they determined that there are significant anatomic variations dependent and independent of sex.…”

Section: -11mentioning

confidence: 99%

“…It has been suggested that MRI, CT or arthroscopy should be used to ensure adequate diagnosis and treatment; [7][8][9][10]12 however, if it is possible to diagnose syndesmotic disruption with plain film radiography, significant cost and morbidity could be spared. Stress examination is another method that has been used to diagnose syndesmotic disruption; 9,[15][16][17] however, use of the mortise and AP views have continued to be the foundation for diagnosis.…”

Section: -11mentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11] It has been suggested that current diagnostic criteria used specifically for syndesmotic injuries are of minimal value and that further criteria should be developed. 5,6,9 Ankle arthroscopy, computed tomography (CT) or magnetic resonance imaging (MRI) have been suggested as alternatives to standard radiography to ensure proper diagnosis of syndesmotic injuries; [7][8][9][10]12 however, none of these options is clinically or economically practical. A potential solution is to add an orthogonal parameter on the lateral radiograph to those being used in the AP and mortise views, thereby increasing their effectiveness.…”

mentioning

confidence: 99%

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Radiographic evaluation of the ankle syndesmosis

Croft

Furey

Stone

et al. 2015

cjs

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Background: Radiographic measurements to document ankle anatomy have been suggested in recent literature to be inadequate. Focus has been put on stress views and computed tomography; however, there are also issues with these modalities. An orthogonal view that could be used both statically and dynamically could help determine syndesmotic stability. The purpose of this study was to determine a parameter on a normal lateral ankle radiograph that will increase the reliability of standard radiography in diagnosing syndesmotic integrity.Methods: Three orthopedic surgeons reviewed 80 lateral ankle radiographs. Thirty of those radiographs were reviewed on a second occasion. Rotation of the radiographs was determined by evaluating the overlap of the talar dome. Four radiographic parameters were measured 1 cm above the tibial plafond: fibular width, tibial width, and anterior and posterior tibiofibular intervals.Results: Seventy-two radiographs were determined by consensus to be adequate. Means and ratios were documented to determine the relationship of the fibula to the tibia. Interrater reliability ranged from moderate to near-perfect, and the intrarater reliability was documented for each ratio. The anterior tibiofibular ratio was shown to be strong to near-perfect. It demonstrates that 40% of the tibia should be seen anterior to the fibula at 1cm above the tibial plafond. Conclusion:The anterior tibiofibular ratio provides an orthogonal measure for the syndesmosis that, in conjunction with those parameters previously documented, could clinically and economically improve the diagnosis of syndesmotic disruptions.

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“…Measurements were documented 1 cm above the centre of the tibial plafond. 8,12 Ratios were determined in order to assess the positional relationship of the tibia relative to the fibula. …”

Section: Methodsmentioning

confidence: 99%