Optaining optimal lateral view of the ankle intraoperative requires optimal positioning and awarness to radiological landmarks to assure good fracture reduction in ankle and distal tibial articular fractures…
–Positioning for optimal view:
The beam is placed perpendicular to plane created by the tibia and the foot.
The beam is centered at the tibiatalar joint space
The ankle joint is in netural position
–Verification of optimal view:
The optimal view is obtained when:
Both talar shoulders are in one plane
Joint space is clearly visible
joint space is symmetrical
Talar, tibial, and fibular assessment is possible
–Anatomical landmarks and lines
The following lines and landmarks are seen:
1-Fibula
2-Tibia
3-Talus
1-Medial malleolus (in blue line)
2-Talar shoulders projected as one line.(red line)
This view is particularly useful to identify:
-Asymmetrical joint space
-Visible gaps or steps in fracture reduction
-Anterior or posterior position of the fibula comparedto contralateral side
-Implant misplacement
-Anteroposterio tibiofibular (APTF) ratio AB/BC = 0.94, indicating correctly reduced syndesmosis
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 and B and the posterior cortex of the tiba.