Ankle & Calcaneus Anatomy Review PDF 2024

Ankle & Calcaneus Rad 101 Reference: Bontrager 10th edition Textbook of Radiographic Positioning and Related Anatomy 11th edition  Learning...

Ankle & Calcaneus Rad 101 Reference: Bontrager 10th edition Textbook of Radiographic Positioning and Related Anatomy 11th edition  Learning Outcomes Explain the anatomy & positioning of calcaneus & ankle Identify the following parts & prominences on an image of the calcaneus & ankle Calcaneus Tibia Fibula https://mystory.msu.edu/wp-content/uploads/2020/01/learning-outcomes.png  Learning Outcomes Identify the structures best shown on routine images of the calcaneus & ankle Describe the routine and special projections for each of the following radiographic procedures: Calcaneus Ankle Discuss why each of the projections may be requested https://mystory.msu.edu/wp-content/uploads/2020/01/learning-outcomes.png Calcaneus Review left calcaneus (superior or proximal surface)  Calcaneus – Os Calcis – Continued Peroneal Trochlea (trochlear process) Visualized laterally on an axial projection Sustentaculum Tali Means “support for the talus” Located on the medial proximal aspect  Calcaneus Review Continued Articulations -How many? Another 2 name for Talus? -Which bones? Talus Cuboid The Talus & Calcaneus form what joint? Subtalar (Talocalcaneal) joint  Calcaneus Review Continued 3 articular facets -Posterior -Middle -Anterior Name of deep depression between the Posterior & Middle articular facets? -Calcaneal Sulcus Ankle Anatomy Fig. 6. 16  Tibia Anatomy Weight bearing bone of lower leg Made of 3 parts Proximal end (extremity) Body (shaft) *Distal end (extremity)  Distal Extremity of Tibia Smaller than proximal extremity Ends in a short “pyramid” shaped process called: Medial malleolus Easily palpated on medial side of ankle Lateral aspect of distal extremity forms a flattened notch – Fibular notch The distal fibula articulates here  Distal Tibia Anatomy Anterior Tubercle Expanded process at the distal anterior & lateral tibia Articulates with the superolateral talus Partially overlaps the fibula anteriorly Tibial Plafond Distal tibial joint surface Forms the roof of the ankle mortise joint Fibula Anatomy Lateral View  Fibula Anatomy Smaller Located laterally & Posteriorly to the larger tibia Articulates with the: Tibia: Proximally & Distally Talus: Distally 3 Parts Proximal Extremity (end) Body (Shaft) *Distal Extremity (end) Lateral View Lateral Malleolus  Ankle Joint Axial View AP View Lateral View  Ankle Joint Formed by 3 Bones Tibia Fibula Talus Inferior portions of the tibia & Fibula form: Mortise : “socket” or three-sided opening The superior Talus fits in here Not seen on a true AP in full Internally rotate the leg 15˚ (Mortise Position) Comparing AP vs Mortise View AP Mortise  Ankle Joint – Lateral View Posterior half of the distal tibia superimposes the fibula Important for evaluation of a true lateral  Ankle Joint – Axial View “looking from the bottom up” Demonstrates the concave inferior surface of the tibia – tibial plafond What does concave mean?  Distance 40 SID Shielding Radiographic Radiation – sensitive organs positioning Collimation considerations Collimate to all four sides without cutting off essential anatomy Positioning Place long axis of the part parallel to long axis of IR Grids Greater than 10 cm  Pediatric Allow parents to help Same centering as adults Special Patient Geriatric Considerations Handle carefully Check for signs of hip fracture (foot in extreme external rotation) Cast conversions What are they? Cast conversion chart  Plantodorsal Axial Calcaneus - Routine Views: Lateral  Plantodorsal Axial - Calcaneous Clinical Indications: Pathologies or fractures with medial or lateral displacement Positioning: Patient supine or seated on table with leg fully extended Dorsiflex foot so that plantar surface is near perpendicular to IR Angle CR 40˚ from vertical Direct CR to base of third metatarsal (CR will emerge at level just distal to lateral malleolus)  Evaluation Criteria (Plantodorsal Calcaneus) Entire calcaneus visualized No rotation Optimal exposure factors Calcaneus Axial Projection We learned what way to do an axial calcaneus? Plantodorsal Triceratops means literally, “three horned face” Dorsoplantar Axial - Place patient in prone position - Elevate ankle on sandbags - Why? - Place IR against the plantar surface of the foot and support with sandbags or cassette holder - CR directed to midpoint of the IR (will emerge at the level of the base of the 5th MT - Caudal angle 40˚ to long axis of foot Dorsoplantar Axial Calcaneus  Dorsoplantar Axial Calcaneus Weight-bearing “coalition view” Standing erect position Place opposite foot one step forward Angle CR 45˚ toward ankle Direct to emerge at level of base of fifth metatarsal  Lateral (Mediolateral) - Calcaneus Clinical Indications: Bony lesions involving calcaneus, talus, and talocalcaneal joint Demonstrate extent and alignment of fractures Positioning: Patient in lateral recumbent position Flex knee on affected limb 45˚ Dorsiflex foot so that plantar surface is at right angle to leg CR perpendicular & directed 1 inch inferior to medial malleolus  Evaluation Criteria (Lateral Calcaneus) Calcaneus and talus visualized No rotation Optimal exposure factors  AP Ankle - Routine Views: AP Mortise Lateral (Mediolateral)  AP - Ankle Clinical Indications: Bony lesions or diseases involving the ankle joint, distal tibia & fibula, proximal talus, and proximal 5th metatarsal Positioning: Patient supine, leg fully extended Do not force dorsiflexion Foot & ankle in true AP CR midway between malleoli  Evaluation Criteria (AP Ankle) Distal ⅓ of tibia and fibula demonstrated Proximal ½ of metatarsals included Medial and superior aspect of ankle joint open  AP Mortise - Ankle Clinical Indications: Evaluation of pathology involving the entire ankle mortise 1 and the proximal fifth metatarsal, a common fracture site. This is a common projection taken during open reduction surgery of the ankle Positioning: Patient supine, leg fully extended Do not dorsiflex foot allow it to remain in natural position Internally rotate leg & foot 15-20˚ (intermalleolar line is parallel to IR) CR perpendicular to IR, direct midway between malleoli  Lateral (Mediolateral) – Ankle Clinical Indications: Projection is useful in the evaluation of fractures, dislocations, and joint effusions associated with other joint pathologies Positioning: Patient in a lateral recumbent position Flex affected limb 45˚ Dorsiflex foot so that plantar surface is at a right angle to leg or as far as patient can tolerate (DO NOT FORCE) CR – Perpendicular to IR, directed to medial malleolus  Evaluation Criteria (Lateral Ankle) Entire talus and calcaneus visualized Lateral malleolus superimposed over posterior half of tibia Optimal exposure factors  Oblique 45˚ Ankle - Special Views: AP Stress (Inversion & Eversion AP & Lateral Weight Bearing  Oblique 45˚ - Ankle Clinical Indications: Pathologies including possible fractures involving distal tibiofibular joint Fractures of distal fibula and lateral malleolus and base of the fifth metatarsal Positioning: Patient supine, legs fully extended Dorsiflex foot if able to (10-15˚ from vertical) Rotate leg & foot medially 45˚ CR Perpendicular to IR, directed midway between malleoli  Evaluation Criteria (45°Oblique Ankle) Distal tibiofibular joint open Distal ⅓ of tibia and fibula demonstrated Proximal ½ of metatarsals included Optimal exposure factors  AP Stress - Ankle Eversion stress Inversion stress Evaluation Criteria (AP Stress Ankle) Distal aspect of tibia and fibula demonstrated Ankle joint to center of collimation field Optimal exposure factors AP Bilateral Weight-bearing Ankle Lateral Weight-bearing Ankle CR: level of ankle joint CR: level of medial malleolus Let’s Review! Anatomy Review (3 of 3)  The sustentaculum tali is found on the: Quiz Me A. Calcaneus B. Talus C. Base of the fifth metatarsal D. Cuboid  The sustentaculum tali is found on the: Quiz Me A. Calcaneus B. Talus C. Base of the fifth metatarsal D. Cuboid  What structure is easily palpated on the medial side of the ankle and is a process off of the distal tibia? Quiz Me: What is the name of the notch located on the lateral aspect of the distal tibia? Where is the anterior tubercle located on the tibia?  What is the name of the portion of the tibia that forms the roof of the mortise joint? Quiz Me: Is the fibula located lateral or medial to the tibia? What structure can be easily palpated on the lateral aspect of the ankle?  What 3 bones forms the ankle joint? Quiz Me: How do you perform the plantodorsal view of the calcaneus? CR location Do you angle the CR? How much? Which direction? How is the foot positioned?  How do you position for the dorsoplantar axial view? (2 different ways to do the projection, 1 laying down, 1 standing) Quiz Me: How is the patient positioned? Where is the CR located? How do you angle the CR? How much?  How do you position a patient for a lateral calcaneus? CR location Quiz Me: Patient position? How do you perform an AP ankle projection? CR location? How is the patient positioned?  How do you perform a AP Mortise view of the ankle? Quiz Me: How do you perform a mediolateral lateral ankle view? How do you perform the 45 degree oblique ankle?  How do you perform the AP stress views of the ankle? Quiz Me: Can you identify all anatomy on the ankle projections? Calcaneus projections? Can you identify the projections being shown on a radiograph of the ankle and calcaneus?