Which radiographic view is most effective for assessing syndesmotic instability in a patient who can tolerate weight bearing?

• A. Mortise view in unilateral stance
• B. Lateral view during stress radiography
• C. AP view with foot in full dorsiflexion
• D. Supine view with toes pointing inward

Answer: (A)

The mortise view in unilateral stance is highly effective for assessing syndesmotic instability because it provides a clear visualization of the interspace between the tibia and fibula at the level of the syndesmosis, particularly when the patient is weight-bearing. This position allows for a functional assessment of the ankle that may reveal any widening of the syndesmosis, which is indicative of instability. During weight-bearing, the relationship between the tibia and fibula can change, making it easier to identify any potential abnormalities that could indicate an injury to the syndesmosis.

This view is advantageous due to its ability to stress the ligaments and provide a realistic representation of the ankle under functional loads. When a patient is bearing weight, the ligaments and joint structures are under stress, potentially uncovering issues that may not be apparent in non-weight-bearing images.

While the lateral view during stress radiography could provide some insight into syndesmotic stability, it may not provide the same level of detail regarding the intertsital relationship of the tibia and fibula that the mortise view does. The AP view with the foot in full dorsiflexion primarily helps in assessing the joint space but does not take advantage of the functional load conditions necessary to stress the synd