Mohammadzadeh Azarabadi Javid, Shalalfa Neveen, Gökkuş Kemal, Shalalfa Saleh
Başkent University, Ankara, Turkey.
Palestine Polytechnic University, Hebron, Occupied Palestinian Territory.
J Orthop Surg Res. 2025 May 14;20(1):461. doi: 10.1186/s13018-025-05886-x.
The distal tibiofibular syndesmosis is a key structure for the ankle joint's stability and function, especially when the body is weight-bearing. Recent literature indicates that weight-bearing radiographs demonstrate superior diagnostic yield compared to non-weight-bearing radiographs. This study aimed to determine the diagnostic yield of the weight-bearing compared to the non-weight-bearing radiographs.
A total of thirty-six healthy adult individuals, with an age group ranging from 18 to 65 years, who had never experienced any trauma, were selected for this study. We performed radiographic imaging in three planes of view: anterior-posterior, lateral, and mortise, for both ankles under both weight-bearing and non-weight-bearing conditions. The tibiofibular clear space, tibiofibular overlap, medial clear space, tibiofibular distance-lateral, anteroposterior tibiofibular ratio, and Lateral Tibial (LT) width were measured.
Tibiofibular clear space and anteroposterior tibiofibular ratio were higher in the weight-bearing position, while tibiofibular overlap, medial clear space, and lateral tibiofibular distance were higher in the non-weight-bearing position. There was a gender effect, as males had higher values for most of the parameters; however, no significant difference was seen in the anteroposterior tibiofibular ratio and tibiofibular distance lateral. The results of this study demonstrate that X-rays of the distal tibiofibular syndesmosis reveal very different outcomes when the person is bearing weight or not pulling weight. These clinically significant differences suggest that weight-bearing radiographs may enhance the identification and diagnosis of syndesmotic injuries. Further studies will be necessary to help with the refinement of the imaging protocols and to improve diagnostic accuracy based on various types of patient demographics.
WB radiographs provide a more functionally accurate assessment of syndesmotic integrity than NWB imaging. They should be incorporated into routine diagnostic protocols, especially for active individuals and those with higher BMI. These findings support the need for demographic-specific imaging strategies to improve diagnostic precision.
胫腓下联合是踝关节稳定性和功能的关键结构，尤其是在身体负重时。近期文献表明，与非负重X线片相比，负重X线片具有更高的诊断价值。本研究旨在确定负重X线片与非负重X线片的诊断价值。
本研究共选取36名年龄在18至65岁之间、从未经历过任何创伤的健康成年人。我们在负重和非负重条件下，对双踝关节进行了前后位、侧位和斜位三个平面的X线成像。测量了胫腓间隙、胫腓重叠、内侧间隙、胫腓外侧距离、胫腓前后径比值以及外侧胫骨（LT）宽度。
负重位时胫腓间隙和胫腓前后径比值较高，而非负重位时胫腓重叠、内侧间隙和胫腓外侧距离较高。存在性别差异，因为大多数参数男性的值更高；然而，胫腓前后径比值和胫腓外侧距离没有显著差异。本研究结果表明，胫腓下联合的X线片在人体负重或不负重时显示出非常不同的结果。这些具有临床意义的差异表明，负重X线片可能会提高对下胫腓联合损伤的识别和诊断。需要进一步的研究来帮助完善成像方案，并根据不同类型的患者人口统计学特征提高诊断准确性。
与非负重成像相比，负重X线片能更准确地评估下胫腓联合的完整性。它们应纳入常规诊断方案，特别是对于活跃个体和BMI较高的个体。这些发现支持了制定针对特定人群的成像策略以提高诊断精度的必要性。
