Ankle Joint Anatomy and Injuries

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Questions and Answers

What is the primary purpose of using stress views in ankle assessments?

To measure joint mobility

To assess the integrity of the syndesmosis and deltoid ligament (correct)

To evaluate bone density

To visualize soft tissue damage

Which condition describes the death of bone tissue due to a loss of blood supply?

Arthritis

Fracture dislocation

Avascular necrosis (correct)

Osteoporosis

What is the key distinction between arthroplasty and arthrodesis?

Arthroplasty is always performed on the hip joint, while arthrodesis is done on the ankle.

Arthroplasty involves open surgery, while arthrodesis is minimally invasive.

Arthroplasty is joint replacement, while arthrodesis is joint fusion. (correct)

Arthrodesis is for sports injuries, while arthroplasty is used for arthritis.

What is an indication that would prompt an ankle X-ray?

Deformity following trauma Signup and view all the answers

Which anatomical structures are associated with the fibula?

Lateral malleolus and apex Signup and view all the answers

What is the recommended kVp and mAs for an AP tib/fib X-ray?

55 kVp and 5 mAs Signup and view all the answers

Which of the following is NOT part of the preparation for an ankle X-ray?

Application of a cast Signup and view all the answers

In which position should the ankle be during the stress view assessment?

In an AP position Signup and view all the answers

What is the required patient position for an AP Tib/Fib X-ray?

Patient supine with legs extended Signup and view all the answers

Which of the following evaluation criteria is NOT included in the AP Tib/Fib evaluation?

Patella positioned off to the side of the femur Signup and view all the answers

What technical factor is specified for the Lateral Tib/Fib X-ray?

kVp of 55 and mAs of 5 Signup and view all the answers

Which joint should be visible and open in the AP Tib/Fib X-ray?

Tibiotalar joint Signup and view all the answers

What is the recommended positioning for the image receptor in a Lateral Tib/Fib X-ray?

Diagonal across the image receptor Signup and view all the answers

What type of joint is the ankle joint classified as?

Synovial hinge joint Signup and view all the answers

Which of the following ligaments is part of the lateral ligament complex of the ankle?

PTFL Signup and view all the answers

What is a common site for fractures that is well visualized in the AP Mortise oblique ankle projection?

Base of the 5th metatarsal Signup and view all the answers

What is the proper patient position when obtaining an AP ankle X-ray?

Legs extended with dorsiflexion of the ankle Signup and view all the answers

Which view of the ankle assesses structural integrity under normal weight-bearing conditions?

Weight-bearing views Signup and view all the answers

For the lateral ankle X-ray, which structure must be superimposed for a true lateral projection?

Medial and lateral malleolus Signup and view all the answers

What ankle joint condition is usually accompanied by a fracture?

Ankle dislocation Signup and view all the answers

Which anatomical structure forms the inferior part of the ankle mortise?

Inferior articular surface of tibia Signup and view all the answers

In an AP ankle view, what should be included in the collimation?

Distal 1/3 of tib/fib and proximal ½ of metatarsals Signup and view all the answers

What condition can cause distal fat pads around the ankle to appear distorted or obliterated?

Fracture Signup and view all the answers

What is the key purpose of the syndesmotic ligament?

To connect the tibia and fibula Signup and view all the answers

Which X-ray technique is specifically used to visualize the talus and proximal metatarsals without overlap?

Mortise oblique Signup and view all the answers

What type of fracture includes the lateral and medial malleolus along with the posterior tibial area?

Tri-malleolar fracture Signup and view all the answers

What should be done to adequately visualize the ankle joint for an X-ray examination?

The ankle and foot must be placed in a vertical position Signup and view all the answers

What is the recommended patient position to ensure a true lateral view of the lower leg during imaging?

Knee flexed with the patella perpendicular to the image receptor Signup and view all the answers

What is the primary reason for performing two views at 90 degrees to each other for lower leg fractures?

To ensure all fractures are visible regardless of orientation Signup and view all the answers

Which of the following is a characteristic of Paget’s disease?

Absorption of old bone and formation of abnormal new bone Signup and view all the answers

What is the appropriate collimation technique for a lateral tib/fib radiographic view?

Collimate to four sides surrounding the outer margins of the leg Signup and view all the answers

Which joint spaces should be included in the evaluation criteria for a lateral tib/fib X-ray?

Tibiotalar and femorotibial joint spaces Signup and view all the answers

What is a common use for external fixations in fracture cases, particularly in pediatrics?

Temporary stabilization until surgical treatment Signup and view all the answers

Which structure is typically superimposed by the lateral malleolus in a lateral view of the lower leg?

The talus Signup and view all the answers

Which type of internal fixation is designed for use within the marrow cavity of the bone?

Intramedullary nailing Signup and view all the answers

Study Notes

Ankle Joint

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.
Three borders form the mortise: 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 joint includes the tibiotalar, subtalar, and distal tibiofibular joints.

Ankle Ligaments

Three main sets of ligaments: medial (deltoid), lateral (PTFL, ATFL, CFL), and syndesmotic.
Achilles injuries are commonly associated with sports activities.

Ankle Fat Pads

Kager fat pads are typically lucent on lateral radiographs.
Obliteration or distortion of fat pad borders can indicate posterior ankle pathology.

Ankle Radiography Indications

Trauma, pain, lumps, foreign body, deformity, swelling, reduced ROM, and infections.

Ankle Radiography Preparation

Correct patient identification, pregnancy check, procedure explanation, removal of shoes, socks, jewelry (anklets, toe rings), patient position on the x-ray table, and lead apron application.

AP Ankle Radiography

kVp: 55 kVp
mAs: 3.2 mAs
FFD: 100-110 cm
CR: 24x30 plate
Center: Midway between medial and lateral malleoli at the level of the malleoli, laterally to skin margins.
Collimation: Include distal 1/3 of tib/fib and proximal ½ of metatarsals.
Patient position: Pt laying on table, with legs extended, heel in contact with image receptor, dorsiflex the ankle and foot to place long axis of foot in vertical position.

AP Ankle Radiography Evaluation Criteria

Regional anatomy included: talus, proximal metatarsals, and 1/3 distal tibia and fibula.
Tibiotalar joint space should be open.
Medial aspect of the mortise joint should be free of superimposition.
Lateral aspect of the joint should have some overlap of the fibula with tibia and talus.
Optimal density and contrast for bone and soft tissue visualization, with no motion.

AP Mortise Oblique Ankle Radiography

kVp: 55 kVp
mAs: 3.2 mAs
FFD: 100-110 cm
CR: 24x30 plate
Center: Midway between medial and lateral malleoli at the level of the malleoli.
Collimation: Include distal 1/3 of tib/fib and proximal ½ of metatarsals.
Patient position: Pt laying on table, with legs extended, heel in contact with image receptor, dorsiflex the ankle so plantar surface of the foot is perpendicular (90 degrees) to image receptor, rotate entire lower leg 15-20 deg internally, placing the intermalleolar plane parallel to image receptor.

AP Mortise Oblique Ankle Radiography Evaluation Criteria

Regional anatomy included: proximal metatarsals, 1/3 distal tibia and fibula.
Entire mortise joint in profile.
Lateral and medial talar-malleolar joints free of overlap.
Base of the 5th metatarsal should be well visualized.
Optimal density and contrast for bone and soft tissue visualization, with no motion.

Lateral Ankle Radiography

kVp: 55 kVp
mAs: 3.2 mAs
FFD: 100-110 cm
CR: 24x30 plate
Center: Over the medial malleolus.
Collimation: Four sides to the outer margins of the ankle.
Patient position: Pt laying on the table, with legs extended, roll patient laterally onto affected side, dorsiflex the foot to prevent lateral rotation of the ankle, superimpose medial and lateral malleoli.

Lateral Ankle Radiography Evaluation Criteria

Regional anatomy included: proximal metatarsals, 1/3 distal tibia and fibula.
Fibular superimposing posterior half of tibia.
Tibiotalar joint open.
Talar domes superimposed.
Lateral malleolus superimposed on the talus.
Calcaneus in profile.
Optimal density and contrast for bone and soft tissue visualization, with no motion.

45 Degree Oblique Ankle Radiography

Similar to the Mortise Oblique view, but with the ankle rolled 45 degrees.
Demonstrates the distal ends of the tibia and fibula, as well as the tibiofibular articulation.

Horizontal Beam Lateral Ankle Radiography

Provides a specific view of the ankle joint.

Weight-Bearing Ankle Views

Performed to assess the joint under normal weight-bearing conditions.
Evaluates structural integrity of the joint.
Often used for follow-up imaging, including fracture healing and syndesmosis injury evaluations.

Ankle Fracture Types

Uni-malleolar: Fracture of either the medial or lateral malleolus.
Bi-malleolar: Fracture of both medial and lateral malleoli.
Tri-malleolar: Includes lateral and medial malleoli and the posterior tibia.

Ankle Dislocation

Often accompanied by a fracture.
Described according to the talus displacement.
Reduction is the surgical procedure to fix a dislocation.

Stress Ankle Views

Used to assess the integrity of the syndesmosis and deltoid ligament.
Performed with the ankle in AP position and an individual stressing the ankle (inversion and eversion).

Syndesmosis Treatment

Various surgical techniques are employed to stabilize syndesmosis injuries.

Avascular Necrosis (AVN)

Can occur following ankle fractures or dislocations due to loss of blood supply.
Leads to the death of bone tissue.

Ankle Surgery

Arthroplasty: Joint replacement.
Arthrodesis: 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.

Tibia and Fibula Joints

Patellofemoral joint.
Proximal and distal tibiofibular joints.
Medial and lateral femorotibial joints.
Talotibial joint.

Tibia and Fibula Radiography Indications

Trauma (MVA, MBA), acute sporting injury, pain, lumps, foreign body, deformity, swelling, infections, previous surgery.

Tibia and Fibula Radiography Preparation

Correct patient identification, pregnancy check, procedure explanation, removal of necessary clothing, gown with opening to the back, patient position on the x-ray table, lead apron application.

AP Tibia and Fibula Radiography

kVp: 55 kVp
mAs: 5 mAs
FFD: 100 cm/110 cm
CR: 35x43 plate
Center: To mid shaft of lower leg, proximal to include knee joint, distal to include ankle joint.
Collimation: Medial/lateral to include soft tissue.
Patient position: Pt supine with both legs extended, rotate leg so femoral condyles are parallel with image receptor, dorsiflex the ankle until foot is vertical.

AP Tibia and Fibula Radiography Evaluation Criteria

Regional anatomy: Distal femur to the talus, including soft tissue.
Ankle and knee joints included and in AP position.
Tibiotalar joint space open.
Femoral and tibial condyles should appear symmetrical.
Patella superimposed on midline of femur.
Proximal and distal fibula slightly superimposed on tibia.
Density and contrast optimal for bone and soft tissue visualization.

Lateral Tibia and Fibula Radiography

kVp: 55 kVp
mAs: 5 mAs
FFD: 100 cm/110 cm
CR: 35x43 plate
Center: To mid shaft of lower leg.
Collimation: Four sides to the outer margins of the leg.
Patient position: Pt supine with affected leg extended, roll Pt towards affected leg, knee flexed to ensure true lateral position, rotate body to place patella perpendicular (90-degrees) to image receptor, superimpose medial and lateral malleoli.

Lateral Tibia and Fibula Radiography Evaluation Criteria

Regional anatomy: Distal femur to the talus, including soft tissue.
Femoraltibial joint space.
Tibiotalar joint space.
Femoral and tibial condyles superimposed.
Fibular distally superimposing posterior half of tibia.
Lateral malleolus superimposed on the talus.
Density and contrast optimal for bone and soft tissue visualization.

Lower Leg Fractures

Two views (at 90 degrees to each other) are essential for proper evaluation.

External Fixations

Used in complex fractures.
Provides temporary stabilization until surgical treatment can be performed.
Commonly utilized for paediatrics to minimize damage to growth plates.

Open Tibia and Fibula Fracture

Occurs when a fractured bone protrudes through the skin.

Internal Fixations

Intramedullary nailing: A rod is inserted into the medullary canal of the bone for stabilization.
Pin and plate ORIF: Pins and a plate are applied to the bone for fracture fixation.

Paget's Disease

A metabolic bone disease characterized by abnormal bone remodeling.
Leads to weakened and deformed bone, increasing fracture risk.
Commonly affects pelvis, skull, femur, tibia, and spine.
Thickened cortex with coarsened trabeculae.

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Description

Explore the intricacies of the ankle joint, including its structure, ligaments, fat pads, and the importance of radiography in diagnosing injuries. This quiz covers essential details about dorsiflexion, plantar flexion, and common pathological indications. Test your knowledge on ankle anatomy and related injuries.