Abstract
BackgroundSyndesmotic injury may be difficult to diagnose, and radiological evaluation is very important. The purpose of this study was to offer a series of reliable and repeatable normal tibiofibular syndesmosis parameters in diagnosing injuries of the syndesmosis.MethodsMulti-detector computed tomography (MDCT) and radiographs of the distal tibiofibular syndesmosis in 484 cases were retrospectively reviewed. Relevant parameters included the tibiofibular clear space (TCS), the tibiofibular overlap (TFO), the depth of the incisura fibularis (IFD), and the height of the incisura fibularis (IFH), which were measured by novel three-dimensional (3-D) and two-dimensional (2-D) techniques. The distance between the measuring plane of the distal tibiofibular syndesmosis and the tibial plafond was measured. Intra- and inter-rater reliability was assessed by intraclass correlation coefficient (ICC) and the root mean square standard deviation (RMS-SD), to determine measurement precision. Sex differences of parameters were analyzed using analysis of covariance (ANCOVA) with body height as the covariate. Paired sample t-testing was used to compare parameters in different image modalities, including radiography, and 2-D and 3-D CT.ResultsThe reliability of the 3-D images measurement (ICC range, 0.907 to 0.972) was greater than that for the 2-D axial images (ICC range, 0.895 to 0.927), and the AP view radiographs (ICC range, 0.742 to 0.838). The intra-rater RMS-SD of the 3-D CT, 2-D CT and radiographic measurements were less than 0.94 mm, 0.26 mm, and 2.87 mm, respectively. The measuring plane of the distal tibiofibular syndesmosis showed the sex difference, which was 12.1 mm proximal to the tibial plafond in the male group and 7.8 mm in the female group. In this plane, the parameters for tibiofibular syndesmosis were measured in different image modalities. All variables were significantly different between females and males (p < 0.05).Conclusions3-D measurement technique could be helpful to identify the precise measurement planes for syndesmosis, which were not at the fixed level above the tibial plafond because of the sex difference. In this plane, reliable measurement results could be provided, in either 2-D or 3-D MDCT images.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0093-6) contains supplementary material, which is available to authorized users.
Highlights
Syndesmotic injury may be difficult to diagnose, and radiological evaluation is very important
The current study demonstrates that the measurement plane for normal tibiofibular syndesmosis should not be at a fixed level above the tibial plafond
Reliable measurements could be provided on that plane, either with 2-D or 3-D Multi-detector computed tomography (MDCT) images
Summary
Syndesmotic injury may be difficult to diagnose, and radiological evaluation is very important. Several clinical tests that are most commonly used in diagnosing injuries of the syndesmosis are described [5,6,7,8]. None of these tests has a high predictive value for acute disruption of the syndesmosis [9]. Radiological evaluation of tibiofibular syndesmosis injury is very important, with attention to the tibiofibular clear space (TCS) and tibiofibular overlap (TFO) [10]. Syndesmotic injury may be difficult to diagnose using radiographs. Recent studies have evaluated CT images to define the normal appearance of the syndesmosis [17, 18, 21], but no clear consensus has been reached
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
