Which radiographic view is best for evaluating the distal tibiofibular joint?

• A. Lateral view
• B. AP view with 0 degrees rotation
• C. AP view with 45 degrees of rotation
• D. Oblique view

Answer: (C)

To assess the distal tibiofibular syndesmosis, you want an image that minimizes overlap between the tibia and fibula so the joint line and any diastasis are visible. An AP view with about 45 degrees of rotation positions the ankle as an oblique projection that opens the distal tibiofibular joint, bringing the tibia and fibula into better alignment on the film. This angle makes it easier to evaluate the syndesmotic space and detect widening or malalignment, which is harder to see with zero rotation. A lateral view isn’t ideal for this joint, and an AP view with no rotation has more overlap, while a general oblique view may vary in angle and not consistently optimize visualization of the distal tibiofibular articulation.