title: Radiographic evaluation of the ankle syndesmosis.
abstract: BACKGROUND
  Radiographic measurements to document ankle anatomy have been suggested in recent literature to be inadequate. Focus has been put on stress views and computed tomography; however, there are also issues with these modalities. An orthogonal view that could be used both statically and dynamically could help determine syndesmotic stability. The purpose of this study was to determine a parameter on a normal lateral ankle radiograph that will increase the reliability of standard radiography in diagnosing syndesmotic integrity.
  
  
  METHODS
  Three orthopedic surgeons reviewed 80 lateral ankle radiographs. Thirty of those radiographs were reviewed on a second occasion. Rotation of the radiographs was determined by evaluating the overlap of the talar dome. Four radiographic parameters were measured 1 cm above the tibial plafond: fibular width, tibial width, and anterior and posterior tibiofibular intervals.
  
  
  RESULTS
  Seventy-two radiographs were determined by consensus to be adequate. Means and ratios were documented to determine the relationship of the fibula to the tibia. Interrater reliability ranged from moderate to near-perfect, and the intrarater reliability was documented for each ratio. The anterior tibiofibular ratio was shown to be strong to near-perfect. It demonstrates that 40% of the tibia should be seen anterior to the fibula at 1cm above the tibial plafond.
  
  
  CONCLUSIONS
  The anterior tibiofibular ratio provides an orthogonal measure for the syndesmosis that, in conjunction with those parameters previously documented, could clinically and economically improve the diagnosis of syndesmotic disruptions.
authors.affiliation: The Department of Orthopaedic Surgery, Memorial University of Newfoundland, St. John's, Nfld.
authors.forename: Stephen
authors.initials: S
authors.lastname: Croft
authors.affiliation: The Department of Orthopaedic Surgery, Memorial University of Newfoundland, St. John's, Nfld.
authors.forename: Andrew
authors.initials: A
authors.lastname: Furey
authors.affiliation: The Department of Orthopaedic Surgery, Memorial University of Newfoundland, St. John's, Nfld.
authors.forename: Craig
authors.initials: C
authors.lastname: Stone
authors.affiliation: The Department of Orthopaedic Surgery, Memorial University of Newfoundland, St. John's, Nfld.
authors.forename: Carl
authors.initials: C
authors.lastname: Moores
authors.affiliation: The Department of Orthopaedic Surgery, Memorial University of Newfoundland, St. John's, Nfld.
authors.forename: Robert
authors.initials: R
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D005260:Female; D005360:Fibula / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015203:Reproducibility of Results; D013977:Tibia / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D055815:Young Adult