A standardised computed tomography measurement method for distal fibular rotation

  • Sven Yves Vetter
  • Martin Gassauer
  • Lorenz Uhlmann
  • Benedict Swartman
  • Marc Schnetzke
  • Holger Keil
  • Jochen Franke
  • Paul Alfred Grützner
  • Nils BeisemannEmail author
Original Article



The aim of the study is to identify an ideal location to measure fibular rotation in the ankle joint using axial computed tomography (CT) scans. Another objective was to detect the average fibular rotation in the uninjured ankle joint in a large cohort.


Standardised axial CT with coronal/sagittal reconstructions was performed in healthy ankle joints. Three investigators performed the measurements. In the axial view, each investigator appointed the ideal location to measure the angle of fibular rotation with the use of reference lines either 4, 6, 8 or 10 mm distal from the talar joint line. Inter- and intraobserver reliability, as well as the intraclass correlation coefficient, were determined.


CT scans of one hundred individuals—78 males and 22 females—were analysed. The most common locations for measuring the fibular rotation were in 31% of cases 4 mm and in 51% of cases 6 mm distal the talar joint line. The external rotation of the fibula averaged 8.42° ± 4.86° (range 0°–26°). The intraclass coefficient correlations (ICC) for interrater and intrarater reliability were 0.75.


The results of the study demonstrate a reproducible location to measure the fibular rotation in the ankle joint. The most convenient location to measure fibular rotation with a high reliability was 6 mm distal to the talar joint line.


Fibular rotation Syndesmotic injury Syndesmosis Cone beam CT Fibular notch 



The research group had grants/grants pending and technical support from Siemens (Erlangen, Germany). Siemens had no involvement in the study design, collection, analysis and interpretation of data, the writing of the manuscript and the decision to submit the manuscript for publication.

Compliance with ethical standards

Conflict of interest

PG and JF are paid members of an advisory board for Siemens. SV, KS, BS, MS, NB and HK declare that they have no competing interests.

Ethical approval

Approval from the local ethics committee was obtained for anonymous analysis of the data. Approval Number: 837.366.14 (9605).

Informed consent

Formal consent is not required for this type of study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sven Yves Vetter
    • 1
  • Martin Gassauer
    • 1
  • Lorenz Uhlmann
    • 2
  • Benedict Swartman
    • 1
  • Marc Schnetzke
    • 1
  • Holger Keil
    • 1
  • Jochen Franke
    • 1
  • Paul Alfred Grützner
    • 1
  • Nils Beisemann
    • 1
    Email author
  1. 1.MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic SurgeryBG Trauma Center Ludwigshafen at Heidelberg University HospitalLudwigshafen am RehinGermany
  2. 2.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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