Tibia fibula (lateral view)

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The tibia fibula lateral view is part of a two view series of the entire tibia, fibula, and both the knee and ankle joint.

Indications

The tibia fibula lateral view is the orthogonal projection to the AP view and is performed for evaluation of fractures or dislocations including their direction of angulation, or in patients suspected to have a foreign body or bone lesion including osteomyelitis.

Patient position

  • the patient is in a lateral recumbent position on the table
  • the lateral aspect of the knee and ankle joint should be in contact with the table resulting in the tibia lying parallel to the table
  • the leg can be bent or straight 
  • place the opposite leg behind the injured limb to avoid over rotation

Technical factors

  • mediolateral projection
  • centering point
    • mid-point between the ankle joint and the knee joint
  • collimation
    • anterior-posterior to the skin margins 
    • superior to the knee joint
    • inferior to ankle joint
  • orientation  
    • portrait or diagonal depending on limb length  
  • detector size
      • 35 cm x 43 cm or 43 cm x 35 cm
  • exposure
    • 50-60 kVp
    • 3-5 mAs
  • SID
    • 100 cm
  • grid
    • no

Image technical evaluation

  • the fibula is projected well posterior to the tibia with superimposition at both proximal and distal ends
  • skin margins are not cut off the image (this is especially important in patients with suspected cellulitis as the soft tissues also get evaluated)

Both the knee joint and the ankle joint are visible if there is suspicion of pathology at either joint, dedicated views should be performed.

Practical points

Placing the detector in a diagonal orientation with an increased SID can heighten your chances of getting the entire lower limb on the one image.

In trauma, it may not be possible to place the patient as above, in these cases the same principles can be applied with a modified horizontal beam view. The patient can remain supine with an image receptor placed vertically adjacent to the lateral aspect of the upright ankle; the X-ray beam is directed horizontally, centered midway between the knee and the ankle joint.

Radiographic views