Systematic Approach to the Radiographic Interpretation of the Ankle and Foot Using a Checklist Approach to Avoid Common Diagnostic Errors

Abstract

Traumatic foot and ankle injuries are common; therefore, radiologists need to be proficient in the interpretation of ankle and foot radiographs. The recognition of common injury patterns through the use of a checklist approach has the potential to improve a radiologist's diagnostic accuracy. The objective of this pictorial essay is to present a simple but thorough checklist for accurate radiographic evaluation of the ankle and foot and review some common injury patterns of the ankle and foot.

Prevalencia de lesiones traumáticas ocultas en muñeca y tobillo: revisión sistemática y metaanálisis

“…Weierich et al 19 proponen el siguiente abordaje sistemático para la evaluación radiográfica de las lesiones del tobillo (Fig. 6): 1) articulación del tobillo, el espacio entre el plafón tibial y el domo talar (normal: 3-4 mm) (aumentado en disrupción de la mortaja); 2) espacio claro medial, distancia entre la corteza medial del astrágalo y la corteza lateral del maléolo medial (normal: 3-4 mm) (aumentado en lesiones del ligamento deltoideo); 3) espacio claro lateral, distancia entre la corteza medial del maléolo lateral y la corteza lateral del astrágalo (normal ≤ 5 mm) (aumentados en lesiones de los ligamentos talofibular anterior, calcaneofibular y talofibular posterior); 4) sindesmosis tibioperoneal distal, compuesta por cuatro ligamentos (tibiofibular inferior anterior y posterior, tibiofibular transverso y ligamentos interóseos) (su ensanchamiento indica desgarro del complejo ligamentario); 5) edema de tejidos blandos (puede indicar lesión ósea o ligamentaria); 6) derrame articular, aumento de la densidad del cojinete graso de Kager o el tejido blando convexo anterior a la articulación tibiotalar (puede indicar lesión articular o ligamentaria); 7) defectos osteocondrales, evaluar la disrupción de la línea cortical blanca, en especial del astrágalo y plafón tibial (su disrupción puede indicar defecto osteocondral), y 8) signo de la V, en la radiografía lateral este signo está formado por la línea blanca cortical del proceso lateral del astrágalo (su disrupción es sugestiva de fractura).…”

Prevalence of missed wrist and ankle traumatic injuries: systematic review and meta-analysis

“…In the lateral projection, the following should be evaluated (Fig. 5): (1) alignment of the radius, carpus, and metacarpals: the radius, lunate, large, and third metacarpals must be aligned (if not, it may indicate dislocation or instability of the carpus); (2) Large lunate (LLA) angles (normal 0-30°) and scapholunate (SLA) angles (normal 30-60°) (when abnormal they may indicate intercarpal ligament injury and intercalated segment instability); the angles vary depending on whether it is a rotary subluxation of the scaphoid (LLA < 30°, SLA > 60°), a dorsal intercalated segment instability or DISI (LLA > 30°, SLA > 60°) or a volar intercalated 19 propose the following systematic approach for the radiographic evaluation of ankle injuries (Fig. 6): (1) ankle joint, the space between the tibial plafond and the talar dome (normal: 3-4 mm) (increased in shroud disruption); (2) medial clear space, distance between the medial cortex of the talus and the lateral cortex of the medial malleolus (normal: 3-4 mm) (increased in deltoid ligament lesions); (3) lateral clear space, distance between the medial cortex of the lateral malleolus and the lateral talus cortex (normal ≤ 5 mm) (increased in lesions of the anterior talofibular, calcaneofibular, and posterior talofibular ligaments); (4) distal tibiofibular syndesmosis, composed of four ligaments (anterior and posterior inferior tibiofibular, transverse tibiofibular, and interosseous ligaments) (its widening indicates tearing of the ligament complex); (5) soft-tissue edema (may indicate bone or ligament injury); (6) joint effusion, increased density of the Kager fat pad or convex soft-tissue anterior to the tibiotalar joint (may indicate joint or ligament injury); (7) osteochondral defects, evaluate the disruption of the white cortical line, especially of the talus and tibial plafond (its disruption may indicate an osteochondral defect), and (8) V sign, on the lateral radiograph this sign is formed by the white line cortex of the lateral process of the talus (its disruption is suggestive of fracture).…”