Radiographic evaluation of the ankle syndesmosis

Croft, Stephen; Furey, Andrew; Stone, Craig; Moores, Carl; Wilson, Robert

doi:10.1503/cjs.004214

Cited by 34 publications

(36 citation statements)

References 18 publications

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“…Dikos et al [23] measured ATFI as 14.6±1.8 mm (11.0-19.4) on CT imaging. In the current study, the ATFI was measured as 12.8±2.4 mm (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) and PTFI as 6.11 mm (3-15) on direct radiographs.…”

Section: Discussionmentioning

confidence: 73%

“…Lateral measurements of ATFI and PTFI have been analyzed more commonly in CT imaging studies. [4,23] In studies by Croft et al, [13] it was reported that the ratio values were more reliable than millimetric measurements. Although the reliability of radiological measurements in CT imaging studies on sagittal planes is high, these values do not provide intraoperative direction.…”

Section: Discussionmentioning

confidence: 97%

“…[12] The patient measurements were evaluated using the anterior tibiofibular ratio (ATFR), anterior tibiofibular interval (ATFI) and posterior tibiofibular interval (PTFI) on the lateral radiographs. [13] Rotation of the radiographs was determined by evaluating the overlap of the talar dome. Mean and median values, lower and upper limits were calculated from the measurements on the AP and lateral radiographs, and were compared with the cut-off values accepted in the literature.…”

Section: Methodsmentioning

confidence: 99%

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The evaluation of radiological measurements used in diagnosis and treatment of syndesmosis injury: A regional study in Turkey

Yaradılmış

2020

Jt Dis Relat Surg

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This study aims to improve the diagnostic reliability of syndesmosis injuries through evaluation of radiological measurements in the Turkish population and to provide mean reference values to prevent malreduction and overcompression during the treatment. Patients and methods: This retrospective study was performed between January 2018 and May 2018. The bilateral anteroposterior (AP) and lateral radiographs of 100 patients (60 males, 40 females; mean age 42.9 years; range, 23 to 72 years) who presented at our polyclinic were analyzed. Tibiofibular overlap (TFO), tibiofibular clear space (TFCS) and medial clear space (MCS) measurements were performed on the AP radiographs. The lateral radiographs were evaluated in respect of the anterior tibiofibular interval (ATFI), posterior tibiofibular interval (PTFI), and anterior tibiofibular ratio (ATFR) for syndesmosis reduction assessment. The lower and upper limits, mean and median values of the measurements were recorded. Results: The measurements on the AP radiographs were determined to be as TFO: 7.9±2.4 mm (4-13), TFCS: 3.8±0.9 mm (2.2-6), MCS: 3.3±0.4 mm (2.7-4.5), and superior clear space: 3.3±0.3 mm (2.7-3.8). According to the measurements on the AP radiographs, the TFCS did not show any difference in terms of the variables of age, gender and side (p=0.070, p=0.219 and p=1.0, respectively). These measurements on the AP radiographs showed a high statistical consistency in terms of side (p=0.72, p=1.0, p=0.900 and p=0.920, respectively). The measurements on the lateral radiographs were as ATFI: 12.8±2.4 mm (8-18), PTFI: 6.1±2.9 mm (3-15) and ATFR: 0.4±0.1 (0.28-0.5). According to the measurements on the lateral radiographs, the ATFR did not show any difference in terms of the variables of age, gender and side (p=0.750, p=0.570 and p=0.848, respectively). The lateral measurements indicated statistical consistency in terms of side (p=0.400, p=0.260 and p=0.848, respectively). Conclusion: On the AP radiographs, TFCS was found to be reliable and the intraoperative evaluation of its high consistency with the opposite extremity is appropriate to avoid overcompression. The evaluation of ATFR on lateral radiographs was found to be reliable and evaluation is recommended to avoid intraoperative malreduction.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

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The evaluation of radiological measurements used in diagnosis and treatment of syndesmosis injury: A regional study in Turkey

Yaradılmış

2020

Jt Dis Relat Surg

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“…Grenier et al [ 32 ] have established a novel radiographic parameter based on the lateral view of the ankle, i.e., the anteroposterior tibiofibular (APTF) ratio, which is normally 0.94 ± 0.13 and can be used to identify and prevent a malreduction of the fibula in the incisura fibularis. Croft et al [ 33 ] showed that the anterior tibiofibular ratio (defined as the ratio of the tibial width to the anterior tibiofibular interval) is reproducibly measured, and is suitable for determining the normal relationship of the tibia and fibula. Some authors used CT to postoperatively evaluate the reduction of the injured syndesmosis [ 21 , 27 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

A reliable radiographic measurement for evaluation of normal distal tibiofibular syndesmosis: a multi‐detector computed tomography study in adults

Chen

Qiang

Kun

et al. 2015

Journal of Foot and Ankle Research

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BackgroundSyndesmotic injury may be difficult to diagnose, and radiological evaluation is very important. The purpose of this study was to offer a series of reliable and repeatable normal tibiofibular syndesmosis parameters in diagnosing injuries of the syndesmosis.MethodsMulti-detector computed tomography (MDCT) and radiographs of the distal tibiofibular syndesmosis in 484 cases were retrospectively reviewed. Relevant parameters included the tibiofibular clear space (TCS), the tibiofibular overlap (TFO), the depth of the incisura fibularis (IFD), and the height of the incisura fibularis (IFH), which were measured by novel three-dimensional (3-D) and two-dimensional (2-D) techniques. The distance between the measuring plane of the distal tibiofibular syndesmosis and the tibial plafond was measured. Intra- and inter-rater reliability was assessed by intraclass correlation coefficient (ICC) and the root mean square standard deviation (RMS-SD), to determine measurement precision. Sex differences of parameters were analyzed using analysis of covariance (ANCOVA) with body height as the covariate. Paired sample t-testing was used to compare parameters in different image modalities, including radiography, and 2-D and 3-D CT.ResultsThe reliability of the 3-D images measurement (ICC range, 0.907 to 0.972) was greater than that for the 2-D axial images (ICC range, 0.895 to 0.927), and the AP view radiographs (ICC range, 0.742 to 0.838). The intra-rater RMS-SD of the 3-D CT, 2-D CT and radiographic measurements were less than 0.94 mm, 0.26 mm, and 2.87 mm, respectively. The measuring plane of the distal tibiofibular syndesmosis showed the sex difference, which was 12.1 mm proximal to the tibial plafond in the male group and 7.8 mm in the female group. In this plane, the parameters for tibiofibular syndesmosis were measured in different image modalities. All variables were significantly different between females and males (p < 0.05).Conclusions3-D measurement technique could be helpful to identify the precise measurement planes for syndesmosis, which were not at the fixed level above the tibial plafond because of the sex difference. In this plane, reliable measurement results could be provided, in either 2-D or 3-D MDCT images.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0093-6) contains supplementary material, which is available to authorized users.

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“…Measurements on lateral radiographs to assess the syndesmosis have not been well defined. Croft and colleagues 53 showed with high reliability that 40% of the tibia was anterior to the fibula at 1 cm above plafond. However, the rotation of the limb can significantly influence each of these measurements 54 except for the TFCS on the AP view.…”

Section: Initial Radiographic Evaluationmentioning

confidence: 98%