title: Contribution of individual projections alone and in combination for radiographic detection of ankle fractures.
abstract: OBJECTIVE
  We wanted to determine whether the standard three-view ankle radiographic series could be replaced by a two-view combination, and if so, which two-view combination (anteroposterior with lateral or mortise with lateral) would be superior.
  
  
  METHODS
  During a 12-month period, we retrospectively reviewed 556 consecutive ankle radiographic studies consisting of anteroposterior, mortise, and lateral views. One hundred twenty patients with at least one ankle fracture were paired with 140 healthy control subjects. Each image in the three-view examination was separated and sorted by view and studied independently; all images were reviewed by two skeletal radiologists and two orthopedic surgeons. Each radiograph was evaluated for fracture of the medial, lateral, and posterior malleoli and the foot using a five-point confidence rating. Performance of each view and modeled two- and three-view combinations of views was evaluated with modified receiver operating characteristic analysis.
  
  
  RESULTS
  The data provide little support for preferring either two-view combination (anteroposterior-lateral or mortise-lateral) for any type of fracture. The three-view combination does detect significantly more fractures than some two-view combinations in some locations, and there is a statistically significant cost in diagnostic accuracy for eliminating the anteroposterior or mortise view.
  
  
  CONCLUSIONS
  Reducing the ankle radiographic series from three to two views would result in a small but significant decrease in the detection of fractures of the ankle and foot. Both two-view combinations are equivalent for fracture detection.
authors.affiliation: Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52240, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Brandser
authors.forename: K S
authors.initials: KS
authors.lastname: Berbaum
authors.forename: D D
authors.initials: DD
authors.lastname: Dorfman
authors.forename: R J
authors.initials: RJ
authors.lastname: Braksiek
authors.forename: G Y
authors.initials: GY
authors.lastname: El-Khoury
authors.forename: C L
authors.initials: CL
authors.lastname: Saltzman
authors.forename: J L
authors.initials: JL
authors.lastname: Marsh
authors.forename: W A
authors.initials: WA
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D000843:Ankle Joint / Q000000981:diagnostic imaging; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D011859:Radiography; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging