Radiographic measurements do not predict syndesmotic injury in ankle fractures: and MRI study

Radiographic measurements do not predict syndesmotic injury in ankle fractures: an MRI study.

Department of Orthopaedic Surgery, Jacobi Medical Center, New York, NY 10021, USA.

Several radiographic measurements have been described and are used to determine ligamentous injury in ankle fractures, particularly of the deltoid and syndesmosis complex. Because the accuracy of these radiographic measurements has been questioned, we sought to evaluate their accuracy using magnetic resonance imaging as an indicator for injury. Seventy patients with closed ankle fractures were entered prospectively into the study, and all had standard plain radiographic evaluations before reduction (anteroposterior, lateral, and mortise) and magnetic resonance imaging. Four radiographic measurements were made on initial ankle injury films: tibiofibular clear space on the anteroposterior view, tibiofibular overlap on the anteroposterior and mortise views, and medial clear space on the mortise view. These radiographic measurements and their association with magnetic resonance imaging findings then were analyzed. A medial clear space measurement greater than 4 mm correlated with disruption of the deltoid and the tibiofibular ligaments. We found no association between the tibiofibular clear space and overlap measurements on radiographs with syndesmotic injury on magnetic resonance imaging scans. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

PMID: 15995444 [PubMed - indexed for MEDLINE]


Consultation with the Specialist: Adolescent Idiopathic Scoliosis

(Pediatrics in Review. 2006;27:299-306.)
© 2006 American Academy of Pediatrics

Consultation with the Specialist: Adolescent Idiopathic Scoliosis

David G. Stewart, Jr, MD*
David L. Skaggs, MD{dagger}
* Childrens Bone and Spine Surgery, Henderson, Nev
{dagger} Editorial Board


After completing this article, readers should be able to:

  1. Discuss the causes and natural history of adolescent idiopathic scoliosis.
  2. List the indications for magnetic resonance imaging in scoliosis patients.
  3. Describe how and when to examine for scoliosis.
  4. Know how to determine the magnitude and pattern of a curve based on standing spine radiographs.
  5. Recognize indications for referral to a specialist.
 Case Presentation

A 16-year-old girl presents with a complaint of spine asymmetry and a history of occasional back pain under her right scapula. She denies bowel or bladder problems and has no neurologic complaints. A right rib hump is apparent on the Adams forward bending test, and she has anterior prominence in the left lower rib cage. No neurologic deficit is noted on examination. Her radiographs demonstrate a 55-degree right thoracic scoliosis from approximately T6 to T12 (Fig. 1). On bending films, the curve bends out to 27 degrees. The patient subsequently undergoes posterior spine fusion from T4 to L1 and has an uneventful postoperative course (Fig. 2). She requires no more pain medicine and returns to school within 3 weeks of the surgery. Six months after the surgery, the patient resumes playing soccer.


Scoliosis is defined as curvature of the spine greater than 10 degrees observed on a standing posterior-anterior (PA) spine radiograph with associated vertebral rotation. The Cobb angle is the angle on the PA view between the superior endplate of the most tilted upper vertebrae and the inferior endplate of the most tilted lower vertebrae.

Scoliosis may occur in association with various conditions. Congenital scoliosis implies failure of segmentation or formation of some vertebral elements and may be associated with fused ribs and spinal cord . . . [Full Text of this Article]


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