Ankle Fracture Season Is Upon Us

by Vince Vacketta, DPM

Now that winter season is in full swing, it's time to talk about ankle fractures. While mastering the syndesmosis has been the shining star in most literature of late, a recent article, “The Tibiofibular Line: A Reliable Method of Syndesmosis Assessment in Certain Fibula Morphologies,” authors Pollizzi A. A., et al. focus on the assessment of fibular length. It’s a great read for any surgeon slushing through a clinic of snow-induced injuries.

It's all about the right perspective

In this article, Pollizzi and his colleagues discuss the relationship of projection angle or image rotation and its influence on fibular length. Simply put, if sagittal rotation is too cranial one may falsely interpret shortening despite adequate reduction and, in contrast, if caudal over-rotation occurs, then a surgeon may have a false-positive for the reduction of fibular length. In addition, these authors evaluated the use of radiographic parameters, such as Shenton's Line and the dime sign, which ultimately may not be as reliable as once thought.

TLDR: Be critical of your intra-op radiographic assessments; sagittal tube angle may trick you!