Rotational ankle injuries are one of the most common musculoskeletal problems treated by orthopaedic surgeons. The distal tibio-fibular syndesmosis may be disrupted during injury resulting in ankle instability. The goal of surgery is to restore anatomic relation of tibia, fibula, and talus. Any malreduction including that of the syndesmosis may result in poor clinical outcomes [1]. While currently accepted radiographic criteria can adequately detect tibio-fibular diasthesis or translation malreductions, it is not yet clear if the currently these criteria are equally suited for detection of rotational malreductions of the tibio-fibular syndesmosis [2]. The goal of this study is to quantify the sensitivity of fluoroscopic measurements of tibio-fibular overlap (TFO) and tibio-fibular clear space (TCS) to rotational malreductions of the syndesmosis. Standard x-ray imaging will be compared with a 3D fluoroscan which will simulate postoperative CT [3].

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