J Korean Foot Ankle Soc.  2017 Dec;21(4):128-134. 10.14193/jkfas.2017.21.4.128.

Clinical Significance of Lateral Ankle Radiograph after the Reduction of a Syndesmosis Injury

• Suh JW
• Park HW

• KMID: 2398009
• DOI: http://doi.org/10.14193/jkfas.2017.21.4.128

Abstract

PURPOSE
To introduce reliable and newly developed radiographic measures based on a lateral ankle radiograph to assess a syndesmotic reduction after screw fixation and to compare with the radiographic measures based on the anteroposterior (AP) and mortise radiographs.
MATERIALS AND METHODS
The postoperative ankle radiographs of 34 ankle fracture cases after screw fixation for concurrent syndesmosis injury were reviewed. Two radiographic parameters were measured on each AP and mortise radiograph; tibiofibular clear space (TFCS) and tibiofibular overlap (TFO). Five radiographic parameters were measured on the true lateral radiographs; the anteroposterior tibiofibular (APTF) ratio, anterior tibiofibular ratio (ATFR), posterior tibiofibular ratio (PTFR), distances of intersection of the anterior fibular border and the tibial plafond to anterior cortex of the tibia (AA"²), and the intersection of posterior fibular border and tibial plafond to the tip of the posterior malleolus (BB"²). In addition, the distance (XP) between the fibular posterior margin (X) crossing tibial plafond or the posterior malleolus and posterior articular margin (P) of the tibial plafond was measured on the lateral view.
RESULTS
Using TFCS and TFO in the AP and mortise radiographs, malreductions of syndesmosis were estimated in 17 of 34 cases (50.0%). Using the introduced and developed radiographic measures in the lateral radiographs, syndesmotic malreductions were estimated in 16 out of 34 cases (47.1%). Seventeen cases (50.0%) showed no evidence of postoperative diastasis using the radiographic criteria on the AP and mortise view, 10 cases (58.8%) of whom showed evidence of a malreduction on the lateral radiograph. The newly developed measurements, XP, were measured 0 in 11 out of 34 cases (32.4%).
CONCLUSION
The reduction of syndemosis after screw fixation can be accurately assessed intraoperatively with a combination of several reliable radiographic measurements of the lateral radiograph and traditional radiographic measurements of the AP and mortise radiograph.

Keyword

Ankle syndesmosis; Ankle fractures; Diastasis; Diagnosis; Radiographs

MeSH Terms

Ankle Fractures
Ankle Joint
Ankle*
Diagnosis
Tibia

Figure

• 

  Figure 1. Grenier’s method7); anteroposterior tibiofibular (APTF) ratio. A: anterior cortex of the tibia at the level of the physeal scar, B: intersection of the anterior cortex of the fibula and the tibial physeal scar, C: intersection of the line crossing A & B and the posterior cortex of tibia. APTF ratio=AB/BC.

• 

  Figure 2. Croft’s method8); anterior tibiofibular ratio (ATFR), posterior tibiofibular ratio (PTFR). AB: tibial plafond, CD: posterior tibiofibular interval (PTFI), DE: the fibular width (FW), EF: anterior tibiofibular interval (ATFI), CF: tibial width (TW). C, D, E, and F were measured 1 cm above the tibial plafond (AB). ATFR=ATFI/TW, PTFR=PTFI/TW.

• 

  Figure 3. Summers’ method1); AA’ and BB’. A: intersection of anterior fibular border and tibial plafond, A’: anterior cortex of tibia, B: intersection of posterior fibular border and tibial plafond, B’: tip of posterior malleolus. AA’ and BB’ were drawn horizontally in talar dome lateral view.

• 

  Figure 4. This study’s method. X: fibular posterior margin crossing tibial plafond or crossing posterior malleolus, P: posterior articular margin of tibial plafond. Two straight vertical lines parallel with tibial anatomical axis were drawn and each line crossed X, P point. The shortest distance within those lines (XP) was measured.

• 

  Figure 5. Relationship of fibula posterior margin and posterior articular margin of tibial plafond. X, P, and XP were same as Fig. 4. (A) X posterior than P; XP=(―). (B) X exactly at P; XP=0. (C) X anterior than P; XP=(+).

• 

  Figure 6. Distribution of the XP distance. Median (Q1, Q3)=0 (―1.10, 2.48).

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