title: Oblique radiograph for the detection of bone spurs in anterior ankle impingement.
abstract: OBJECTIVE
  The aim of this study was to develop a radiographic view to detect anteromedial talotibial osteophytes that remain undetected on standard radiographs.
  
  
  METHODS
  In 10 cadaver specimens the maximal size was measured of anteromedial tibial osteophytes that remain undetected on a standard lateral radiograph projection, due to the presence of the anteromedial tibial rim. The average projection of the most prominent anterolateral tibial rim over the anteromedial rim was found to be 7.3 mm. A 7 mm barium-clay osteophyte was attached to this anteromedial rim of the distal tibia. Anteromedial osteophytes become most prominent on an oblique view, in which the radiographic beam is tilted into a 45 degrees craniocaudal direction with the leg in 30 degrees external rotation. This oblique view was compared with the findings of arthroscopic surgery in 25 consecutive patients with anterior ankle impingement syndrome.
  
  
  RESULTS
  Medially located tibial and talar osteophytes remained undetected on a standard lateral projection and became visible on the oblique anteromedial impingement (AMI) radiograph. Anterolateral tibial and talar osteophytes were well detected on a standard lateral radiograph projection but were invisible on the AMI view. There was a high correlation between the location of the osteophyte and the location of symptoms and the findings at arthroscopy.
  
  
  CONCLUSIONS
  A combination of lateral and oblique radiographs can be used to differentiate between anteromedial and anterolateral bony ankle impingement.
authors.affiliation: Department of Orthopedic Surgery, Academic Medical Center, Postbox 22700, 1100 DE Amsterdam, The Netherlands. hanstol@hotmail.com
authors.forename: C Niek
authors.initials: CN
authors.lastname: van Dijk
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Wessel
authors.forename: Johannes L
authors.initials: JL
authors.lastname: Tol
authors.forename: M
authors.initials: M
authors.lastname: Maas
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001696:Biomechanical Phenomena; D005096:Exostoses / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D013628:Talus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery