Ankle fracture radiological examination – how much is enough?

To create radiological examination system for ankle fracture preoperative assessment and postoperative result evaluation. It is part of study about complex ankle fracture treatment, with specific interest in fractures with posterior malleolus involvement. Literature review was performed identifying various radiological measurements used for ankle fracture pre- and post- operative diagnostics. Measurement techniques with high reliability and potential to be introduced in clinical practice were selected, including new measurement variations. Following radiological examination and measurement algorithm was created for pre- and post- operative diagnostics: Plain x-ray – used for all ankle fractureProjections – AP, Lateral, Mortise view, +/- weight bearing AP both legs (specific conditions)Measurements performedAnkle joint clear spaces – medial, superior, lateralPresence of fractures – lateral malleolus, medial malleolus, posterior malleolus, small fragments (Tillaux-Chapi, Wagstaffe)Computed tomography (CT) – used for ankle fractures with posterior malleolus involvement or other specific intraarticular fracture extensionsCT is performed for both legs in one examination , to gain information of normal anatomy of the uninjured sideImages in axial, coronal and sagittal planes are obtainedMeasurements performedFibula length in coronal planeFracture gap in articular surface in all planesTibiofibular syndesmosis position according to Phisitkul et al. – depth and engagement, in axial planeFibula torsional position Although numerous radiological examination and measurement methods are available, not all of them are convenient for everyday clinical use due to various reasons. Our presented algorithm allows measurements for all clinically relevant fracture placements using plain x-ray and CT images. In addition, it is easy to adapt for routine use.