Injuries to the superior ankle joint from the viewpoint of accident surgery]

The treatment of bony, osteochondral, and ligamentous injuries of the tibio-talar joint requires precise preoperative planning by radiological investigation. This is essential to a correct understanding of the underlying pathology and will allow a proper classification of the injury, which is the basis of treatment. Conventional radiography using anteroposterior and lateral X-rays with comparative views of the noninjured side and, if necessary, rotated spot views and tomography are of high value especially in osteochondral fractures of the talus. Intraoperative control images in both planes after osteosynthesis are mandatory. For evaluation of the postoperative course and severity of arthrosis formation, the classification system of Bargon has proved its worth. In addition, tomography of the tibio-talar joint in two planes is useful especially in tibial pilon fractures, some malleolar fractures, and peripheral talar fractures. In talar fracture dislocations with concomitant compartment syndrome an emergency CT scan can be helpful to determine the optimal surgical approach. In these cases a 3-D reconstruction also might be of assistance. If there is evidence of partial or total talar necrosis, magnetic resonance imaging can be extremely helpful. However, in most cases implants considerably limit the validity of the image obtained. Ultrasonography offers a noninvasive, reproducible, and very inexpensive alternative and should be performed in cases of chondral-osteochondral talar rim avulsions and juvenile osteochondral ligament ruptures. It can also be used as a dynamic method for stress examination in fibular ligament ruptures and soft tissue injuries such as dislocation of the peroneal tendons. The use of Arthrography, stress tenography, and Arthro-CT scan nowadays has become extremely limited.