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Questions and Answers
What is the required patient leg position for an accurate AP TIB/FIB radiograph?
What is the required patient leg position for an accurate AP TIB/FIB radiograph?
Which of the following criteria is NOT part of evaluating an AP TIB/FIB radiograph?
Which of the following criteria is NOT part of evaluating an AP TIB/FIB radiograph?
When performing a lateral TIB/FIB X-ray, what is the recommended tube angulation?
When performing a lateral TIB/FIB X-ray, what is the recommended tube angulation?
What kVp setting is recommended for the lateral TIB/FIB radiograph?
What kVp setting is recommended for the lateral TIB/FIB radiograph?
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To ensure both knee and ankle joints are included in a lateral TIB/FIB radiograph, how should the lower leg be positioned on the imaging receptor?
To ensure both knee and ankle joints are included in a lateral TIB/FIB radiograph, how should the lower leg be positioned on the imaging receptor?
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What is the purpose of stress views in ankle assessments?
What is the purpose of stress views in ankle assessments?
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Which condition is also known as osteonecrosis?
Which condition is also known as osteonecrosis?
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What is the difference between arthroplasty and arthrodesis?
What is the difference between arthroplasty and arthrodesis?
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In an AP Tib/Fib X-ray, what does the center point of the image focus on?
In an AP Tib/Fib X-ray, what does the center point of the image focus on?
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Which of the following is a common indication for ankle surgery?
Which of the following is a common indication for ankle surgery?
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Which anatomical structures compose the fibula?
Which anatomical structures compose the fibula?
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What is a significant risk following an ankle fracture or dislocation?
What is a significant risk following an ankle fracture or dislocation?
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During preparation for an X-ray, which step is essential for patient safety?
During preparation for an X-ray, which step is essential for patient safety?
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What is the recommended position to take an adequate lateral view of the lower leg?
What is the recommended position to take an adequate lateral view of the lower leg?
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What is the primary benefit of using external fixations in fractures?
What is the primary benefit of using external fixations in fractures?
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Which imaging characteristics should be evaluated for a lateral tib/fib projection?
Which imaging characteristics should be evaluated for a lateral tib/fib projection?
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In aspects of Paget's disease, which of the following statements is true?
In aspects of Paget's disease, which of the following statements is true?
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What does adequate collimation refer to when taking a lateral leg film?
What does adequate collimation refer to when taking a lateral leg film?
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What is a critical feature to assess in fractures at 90 degrees to each other?
What is a critical feature to assess in fractures at 90 degrees to each other?
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Which type of fixation is preferred for surgical intervention in complex fractures?
Which type of fixation is preferred for surgical intervention in complex fractures?
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Which of the following descriptions best fits an open tib/fib fracture?
Which of the following descriptions best fits an open tib/fib fracture?
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What type of joint is the ankle joint classified as?
What type of joint is the ankle joint classified as?
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Which ligament is part of the medial ligament group in the ankle?
Which ligament is part of the medial ligament group in the ankle?
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What indicates a potential pathology in the posterior ankle on a radiograph?
What indicates a potential pathology in the posterior ankle on a radiograph?
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In which view should the foot be positioned to visualize the ankle joint correctly during X-ray imaging?
In which view should the foot be positioned to visualize the ankle joint correctly during X-ray imaging?
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Which of the following correctly describes the evaluation criteria for a lateral ankle X-ray?
Which of the following correctly describes the evaluation criteria for a lateral ankle X-ray?
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What positioning is required for the AP mortise oblique ankle view?
What positioning is required for the AP mortise oblique ankle view?
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Which of the following ankle fractures involves all three malleoli?
Which of the following ankle fractures involves all three malleoli?
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What is typically the common site of fracture shown well in the AP mortise oblique view?
What is typically the common site of fracture shown well in the AP mortise oblique view?
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What is a primary indication for performing an X-ray of the ankle?
What is a primary indication for performing an X-ray of the ankle?
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What is the correct way to describe an ankle dislocation?
What is the correct way to describe an ankle dislocation?
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Which view is most appropriate for assessing fracture healing in the ankle?
Which view is most appropriate for assessing fracture healing in the ankle?
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During the preparation phase for an ankle X-ray, which of the following must be done?
During the preparation phase for an ankle X-ray, which of the following must be done?
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What is the recommended collimation for an AP ankle X-ray?
What is the recommended collimation for an AP ankle X-ray?
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Study Notes
The Ankle
- The ankle joint is a synovial hinge joint, responsible for dorsiflexion and plantar flexion.
- The ankle mortise is a gliding joint, formed by the distal ends of the tibia and fibula, and the proximal end of the talus.
- The ankle mortise is formed by three borders: the articular facet of the lateral malleolus, the articular facet of the medial malleolus, and the inferior articular surface of the tibia and superior margin of the talus.
- The ankle is comprised of the tibiotalar joint, subtalar joint, and the distal tibiofibular joint.
- The distal tibiofibular joint is a syndesmosis.
Ankle Ligaments
- The ankle has three main sets of ligaments: the medial deltoid ligament, the lateral ligaments (PTFL, ATFL, and CFL), and the syndesmotic ligaments.
- Achilles injuries happen during physical activity.
Ankle Fat pads
- The Kager fat pads are normally lucent on a lateral radiograph.
- Obliteration or distortion of the Kager fat pad borders can indicate pathology in the posterior ankle.
Indications for Imaging
- Ankle imaging is indicated for trauma, pain, lumps, loss of function, foreign bodies, deformity, swelling, reduced range of motion, and infections.
Preparing for Ankle Imaging
- The patient must be identified correctly.
- A pregnancy check is required.
- The procedure must be explained.
- Shoes, socks, and jewelry must be removed.
- The patient can sit or lie on the x-ray table.
- A lead apron is used for protection.
AP Ankle Radiography
- The long axis of the imaging receptor is parallel to the long axis of the ankle.
- The center of the CR is midway between the medial and lateral malleoli at the level of the malleoli, lateral to skin margins.
- Collimate to include the distal 1/3 of the tibia and fibula, and the proximal 1/2 of metatarsals.
- The patient should be laying on the x-ray table with their legs extended and the heel in contact with the image receptor.
- The ankle and foot should be dorsiflexed to position the long axis of the foot vertically.
AP Ankle Radiographic Evaluation
- The regional anatomy, including the talus, the proximal metatarsals, the distal 1/3 of the tibia and fibula, and soft tissue, should be included.
- The tibiotalar joint space should be open.
- The medial aspect of the mortise joint should be free from superimposition.
- The joint should not be open laterally, some overlapping of the fibula with the tibia and talus is normal.
- Density and contrast should be optimal to visualize bone and soft tissue, with no motion.
AP Mortise Oblique Ankle Radiography
- The long axis of the imaging receptor is parallel to the long axis of the ankle, centered midway between the medial and lateral malleoli at the level of the malleoli.
- Collimate to include the lateral to skin margins, distal 1/3 of the tibia and fibula, and proximal 1/2 of metatarsals.
- The patient should be laying on the x-ray table with their legs extended and the heel in contact with the image receptor.
- The ankle should be dorsiflexed so the plantar surface of the foot is perpendicular (90 degrees) to the image receptor. From the AP position, rotate the entire lower leg 15-20 degrees internally, placing the intermalleolar plane parallel to the image receptor.
AP Mortise Oblique Ankle Radiographic Evaluation
- The regional anatomy, including the proximal metatarsals, the distal 1/3 of the tibia and fibula, and soft tissue, should be included.
- The entire mortise joint should be in profile.
- The lateral and medial talar-malleolar joint should be free of overlap.
- The base of the 5th metatarsal should be visualized.
- Density and contrast should be optimal to visualize bone and soft tissue, with no motion.
Lateral Ankle Radiography
- The long axis of the imaging receptor is parallel to the long axis of the ankle, centered over the medial malleolus.
- Collimate to the outer margin of the ankle, on all four sides.
- The patient should be laying on the x-ray table with their legs extended and rolled laterally onto the affected side.
- The foot should be dorsiflexed to prevent lateral rotation of the ankle, superimposing the medial and lateral malleoli.
- Consider placing a sponge under the foot to help facilitate a true lateral projection.
Lateral Ankle Radiographic Evaluation
- The regional anatomy, including the proximal metatarsals, the distal 1/3 of the tibia and fibula, and soft tissue, should be included.
- The fibular should superimpose the posterior half of the tibia.
- The tibiotalar joint should be open.
- The talar domes should superimpose.
- The lateral malleolus should superimpose the talus.
- The calcaneous should be in profile.
- Density and contrast should be optimal to visualize bone and soft tissue, with no motion.
45 Degree Oblique Ankle Radiography
- The position is the same as the Mortise Oblique View with the ankle rolled 45 degrees.
- This view visualizes the distal ends of the tibia and fibula, as well as the tibiofibular articulation.
Weight Bearing Views
- Weight bearing views are useful for assessing the structural integrity of the ankle joint under normal weight-bearing conditions.
- They can be helpful in evaluating fracture healing and syndesmosis injuries.
Ankle Fractures
- Ankle fractures are classified as uni-malleolar (medial or lateral), bi-malleolar, or tri-malleolar (including lateral and medial malleolus, as well as the posterior tibia).
Ankle Dislocation
- Ankle dislocations often occur with a fracture.
- Ankle dislocation is described by the displacement of the talus.
- The surgical procedure to fix a dislocation is called a reduction.
Stress Views
- Stress views are specialized views used to assess the integrity of the syndesmosis and deltoid ligaments.
- The ankle is placed in the AP position and then stressed by applying inward (inversion) and outward (eversion) stress.
Syndesmosis Treatment
- Syndesmosis injuries are treated with surgery, often using fixation screws.
Avascular Necrosis (AVN)
- There is a risk of AVN after an ankle fracture or dislocation due to loss of blood supply.
- AVN is the death of bone tissue due to loss of blood supply.
- AVN is also known as osteonecrosis.
Ankle Surgery
- Arthroplasty is a joint replacement.
- Arthrodesis is a joint fusion.
Tibia and Fibula
Anatomy
- Tibia: tibial plateaus, intercondylar eminences, medial and lateral tibial condyles, tibial tuberosity, medial malleolus.
- Fibula: apex, head, neck, lateral malleolus.
- Talus
Joints
- Patellofemoral joint, proximal and distal tibiofibular joint, medial and lateral femorotibial joints, talotibial.
Indications for Imaging
- Tibia and fibula imaging is indicated for trauma (MVA, MBA), acute sports injuries, pain, lumps, foreign bodies, deformity, swelling, infections, and previous surgery.
Preparing for Tibia and Fibula Imaging
- The patient must be identified correctly.
- A pregnancy check is required.
- The procedure must be explained.
- Necessary clothing must be removed, and a patient must be gowned with an opening in the back.
- The patient must lie on the x-ray table.
- A lead apron should be utilized.
AP Tib/Fib Radiography
- The long axis of the image receptor should be diagonal to the lower leg to ensure both the knee and ankle joint are included.
- The center of the CR should be on the mid shaft of the lower leg, proximal to include the knee joint, and distal to include the ankle joint. Collimate medial and lateral to include soft tissue.
- The patient should be supine with their legs extended, rotating the leg so the femoral condyles are parallel to the image receptor.
- Dorsiflex the ankle until the foot is vertical.
AP Tib/Fib Radiographic Evaluation
- The regional anatomy, including the distal femur, talus, and soft tissue, should be included.
- The ankle and knee joints should be included, and in an AP position.
- The tibiotalar joint space should be open.
- The femoral and tibial condyles should appear symmetrical.
- The patella should be superimposed on the midline of the femur.
- The proximal and distal fibula should be slightly superimposed on the tibia.
- Density and contrast should be optimal to visualize bone and soft tissue.
Lateral Tib/Fib Radiography
- The long axis of the image receptor should be diagonal to the lower leg, to ensure both the knee and ankle joint are included.
- The center of the CR should be on the mid shaft of the lower leg. Collimate to the outer margins of the leg.
- The patient should be supine with the affected leg extended, and rolled toward the affected leg with the other leg either in front or behind for support.
- Flex the knee to ensure a true lateral position. Rotate the body to place the patella perpendicular (90 degrees) to the image receptor.
- Superimpose the medial and lateral malleoli.
Lateral Tib/Fib Radiographic Evaluation
- The regional anatomy, including the distal femur, talus, and soft tissue, should be included.
- The femoral tibial joint space and tibiotalar joint space should be visualized.
- The femoral and tibial condyles should superimpose.
- The fibular should distally superimpose the posterior half of the tibia.
- The lateral malleolus should superimpose the talus.
- Density and contrast should be optimal to visualize bone and soft tissue.
Lower Leg Pathology
- Two views at 90-degrees to each other are important for evaluating lower leg pathology.
Fractures
- Fractures of the tibia and fibula are common and can occur in isolation or together.
External Fixation
- External fixation is a temporary stabilization method used for complex fractures.
- It is used when surgical treatment cannot be safely performed immediately or in pediatric cases when pins could damage the growth plate.
Internal Fixation
- Internal fixation is a surgical method that uses implants, such as plates and screws, to stabilize a fracture.
- Internal fixation methods include intramedullary nailing and pin and plate open reduction internal fixation (ORIF).
Paget's Disease
- Paget's disease is a metabolic disease in which the body absorbs old bone and forms new bone abnormally.
- The bone is weakened, deformed and more prone to fractures.
- It affects the pelvis, skull, femur, tibia and spine.
- The cortex of the bone is thickened with coarsened trabeculae.
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Description
Explore the anatomy and biomechanics of the ankle joint, including its structure and function. This quiz covers the different joints, ligaments, and fat pads of the ankle, as well as common injuries associated with it. Test your knowledge on this critical component of human movement.
