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The proximal extent of the ankle capsule and safety for the insertion of percutaneous fine wires

Trauma and Orthopaedic Department, Leicester Royal Infirmary, Leicester LE1 5WW, UK, Orthopaedic Department, 550 Harrison Street, Suite 100, Syracuse, New York 13202, USA, Radiology Department, Orthopaedic Department, Addenbrooke’s Hospital NHS Trust, Cambridge CB2 2QQ, Cambridgeshire, UK.

Correspondence should be sent to Mr P. T. H. Lee; e-mail: PL256{at}cam.ac.uk

We have assessed the proximal capsular extension of the ankle joint in 18 patients who had a contrast-enhanced MRI ankle arthrogram in order to delineate the capsular attachments.

We noted consistent proximal capsular extensions anterior to the distal tibia and in the tibiofibular recess. The mean capsular extension anterior to the distal tibia was 9.6 mm (4.9 to 27.0) proximal to the anteroinferior tibial margin and 3.8 mm (–2.1 to 9.3) proximal to the dome of the tibial plafond. In the tibiofibular recess, the mean capsular extension was 19.2 mm (12.7 to 38.0) proximal to the anteroinferior tibial margin and 13.4 mm (5.8 to 20.5) proximal to the dome of the tibial plafond.

These areas of proximal capsular extensions run the risk of being traversed during the insertion of finewires for the treatment of fractures of the distal tibia. Surgeons using these techniques should be aware of this anatomy in order to minimise the risk of septic arthritis.