Sven Vetter, Benedict Swartman, Nils Beisemann, Jochen Franke
Markku T Nousiainen
Intraoperative imaging is essential in reduction and fixation of fractures with or without an unstable syndesmotic injury.
The knowledge of anatomical relations and the identification of landmarks facilitate anatomical reduction and implant placement.
The following are particularly useful:
The following represents ideal imaging with the patient placed in the supine position.
The relation between the foot and the C-arm and the foot is the same for patients in the lateral decubitus and prone positions. The orientation of the C-arm has to be adjusted accordingly.
Taking intraoperative images of the contralateral ankle for comparison purposes can be useful to ensure that an anatomical reduction of the injured ankle is achieved.
The optimal view is obtained when the:
If the optimal view cannot be obtained, this is most likely due to a nonreduced fracture.
The following lines and landmarks can be observed:
Definition Weber ball: Circle between distal fibula and the lateral aspect of the talus.
Definition of Shenton’s line: Medial aspect of the fibular joint surface and distal tibal joint surface.
Both an uninterrupted Shenton's line and presence of the Weber ball indicates correct fibular length.
This view is particularly useful to identify:
The optimal view is obtained when:
The following lines and landmarks are seen:
The correct placement of the axial plane is perpendicular to the sagittal and coronal plane.
The following lines, landmarks and parameters can be observed:
Typical fracture patterns that are easily recognized are:
The following lines and landmarks and parameters can be observed:
Both medial and lateral talar surfaces
Fibular rotation may also be observed.