Projection of ankle For the experiences of my work and let my work be seen all over so that people may get the knowledge of angle from my PPT and easy to understand fast .

1. PROJECTION OF ANKLE
BY, KARSANG FENGTE
COURSE: BMRIT 3RD SEM
DEPARTMENT: UCHS
SUBMITTED TO: ROHIT RANJAN
SIR

2. TABLE OF CONTENT
1.Introduction
2.Anatomy
3.Basic views of ankle
.AP projection
.AP mortise 15˚
.Lateral
4.Special views of ankle
.Oblique45˚
.AP stress

3. INTRODUCTION
ANATOMY OF ANKLE
1.Bones in the ankle
➢ Three bones make up your
ankle joint:
➢ Tibia (shin bone)
➢ Fibula (calf bone)
➢ Talus
2.Cartilage
• Hyaline cartilage

4. 3. LIGAMENTS:
• Medial ligaments (deltoid
ligaments)
• Lateral ligament
• Syndesmotic ligaments
4. MUSCLES:
a. Plantarflexion
• Gastrocnemius.
• Soleus.
• Plantaris.
• Tibialis posterior.
• Flexor digitorum longus.
• Flexor hallucis longus.
• Peroneus brevis.
• Peroneus longus.
b. Dorsiflexion
• Tibialis anterior.
• Extensor digitorum longus.
• Extensor hallucis longus.
• Peroneus tertius.

5. BASIC VIEWS OF ANKLE
1.AP PROJECTIONS
2.AP MORTISE 15°
3. LATERAL
1.AP PROJECTIONS: ANKLE
➢ INDICATIONS:
• ankle trauma
• bony tenderness at the posterior edge or the tip of the lateral
malleolus
• bony tenderness at the posterior edge or the tip medial malleolus
• inability to weight bear
• non-traumatic ankle pain

6. ➢ TECHNICAL FACTOR:
• SID- 100cm(40 inches)
• IR size - 24 x 30 (10 x 12 inches)
• Detail screen
• Digital IR - use lead masking
• kVp – 50-60
• mAs – 3-5
• No grid
➢ PATIENT POSITION:
• the patient may be supine or sitting
upright with their leg straighten on the
table
• the foot is in dorsiflexion
• the toes will be pointing directly toward
the ceiling

7. ➢ PART POSITION:
• Center and align ankle joint to CR
and to long axis of portion of IR
being exposed
• Do not force dorsiflexion of the
foot; allow it to remain in its natural
position
• Adjust the foot and ankle for a true
AP projection. Ensure that the
entire lower leg is not rotated. The
intermalleolar line should not be
parallel to IR

8. ➢ CR:
• CR perpendicular to IR, directed to a point midway between malleoli
➢ COLLIMATION:
• Collimate to lateral skin margins
• include proximal one-half of metatarsals and distal tibia- fibula.
2. AP MORTISE P ROJECTION—15 ° TO 20 ° MEDIAL ROTATION
➢ INDICATION:
• assessment of fragment position and implants in postoperative follow up
• evaluation of fracture healing
• osteochondral injuries of the talus
• osteoarthritis of the ankle

9. ➢ TECHNICAL FACTOR:
• SID- 100cm(40 inches)
• IR size - 24 x 30 (10 x 12 inches)
• Detail screen
• Digital IR - use lead masking
• kVp – 50-60
• mAs – 3-5
• No grid
➢ PATIENT POSITION:
• Place patient in the supine position
• place pillow under patient’s head
• legs should be fully extended

10. ➢ PART POSITION:
• Center and align ankle joint to CR
and to long axis of portion of IR
being exposed.
• Do not dorsiflex foot, but allow to
remain in natural extended (plantar
flexed) position (allows for
visualization of base of fifth
metatarsal - a common fracture
site).
• Internally rotate entire leg and foot
about 15 to 20 degrees until
intermalleolar line is parallel to IR.
• Place support against foot if needed
to prevent motion.

11. ➢ CR:
• CR perpendicular to IR, directed to a point midway between malleoli
➢ COLLIMATION:
• Collimate to lateral skin margins
• include proximal metatarsals and distal tibia- fibula.
3. LATERAL—MEDIOLATERAL PROJECTION
➢ INDICATIONS:
1. evaluation of fractures (broken ankles),
2. sprains,
3. dislocations, and joint effusions associated with other joint pathologies.

12. ➢ TECHNICAL FACTOR:
• SID- 100cm(40 inches)
• IR size - 24 x 30 (10 x 12 inches)
• Detail screen
• Digital IR - use lead masking
• kVp – 50-60
• mAs – 3-5
• No grid
➢ PATIENT POSITION:
• Place patient in the lateral recumbent
position, affected side down
• give pillow for head
• flex of affected limb about 45 degree
• place opposite leg behind the injured
limb to prevent over rotation.

13. ➢ PART POSITION:
• Center and align ankle joint to CR and to
long axis of portion of IR being exposed
• Place support under knee as needed to
place leg and foot in true lateral position
• Dorsi ex foot so that plantar surface is at
a right angle to leg or as far as patient
can tolerate; do not force. (This helps
maintain a true lateral position.
➢ CR:
• CR perpendicular to IR, directed
to a point midway between
malleoli
➢ COLLIMATION:
• Collimate to include distal tibia
and fibula to mid metatarsal
area

14. SPECIAL VIEWS OF ANKLE
1. OBLIQUE 45˚
2. AP STRESS
1.AP OBLIQUE P ROJECTION—45° MEDIAL ROTATION
➢ INDICATIONS:
1. Pathologies, including possible fractures involving the distal tibiofibular joint, the
distal fibula and lateral malleolus
2. the base of the fifth metatarsals, are demonstrated.

15. ➢ TECHNICAL FACTOR:
• SID- 100cm(40 inches)
• IR size - 24 x 30 (10 x 12 inches)
• Detail screen
• Digital IR - use lead masking
• kVp – 50-60
• mAs – 3-5
• No grid
➢ PATIENT POSITION:
• Take radiograph with patient in the
supine position
• place pillow under head
• legs should be fully extended (small
sandbag or other knee increases comfort
of patient).

16. ➢ PART POSITION:
• Center and align ankle joint to CR and to
long axis of potion of IR being exposed.
• If patient's condition allows, dorsiflex the
foot id needed so that the plantar
surface is at least 80 to 85 degree from
the IR (10 to 15 degrees from vertical).
see note below
• Rotate leg and foot internally 45
degrees.
➢ CR:
• CR perpendicular to IR,
directed to a point midway
between malleoli
➢ COLLIMATION:
• Collimate to include distal
tibia and fibula to mid
metatarsal area

17. AP STRESS PROJECTIONS: ANKLE
INVERSION AND EVERSION POSITION
➢ INDICATIONS:
1. Pathology involving ankle joint
separation secondary to ligament tear
2. rupture
➢ TECHNICAL FACTORS:
• SID- 100cm(40 inches)
• IR size - 24 x 30 (10 x 12 inches)
• Detail screen
• Digital IR - use lead masking
• kVp – 50-60
• mAs – 3-5
• No grid
➢ PATIENT POSITION:
• Place patient in supine position
• place pillow under patient’s
head
• leg should be fully extended,
with support under knee.

18. ➢ PART POSITION:
• Center and align ankle joint to
CR and to long axis of portion of
IR being expose
• Dorsi ex the foot as near the
right angle to the lower leg as
possible
• Stress is applied with leg and
ankle in position for a true AP
with no rotation, wherein the
entire plantar surface is turned
medially for inversion and
laterally for eversion.
➢ CR:
• CR perpendicular to IR, directed
to a point midway between
malleoli
➢ COLLIMATION:
• Collimate to lateral skin margins,
including proximal metatarsals and
distal tibia- fibula