• Lateral malleolar shortening is seen as disruption of subchondral bone continuity along the fibula relative to the lateral tibia at the joint level. A smooth arc should join the two subchondral surfaces, but in the displaced bimalleolar fracture seen in Figure 1, the subchondral bone does not match the normal contour of the talus (Fig. 1A and 1B). The result is an increase above normal in the talocrural angle (Fig. 1C); a small amount of malleolar shortening is present also.

• Lateral talar shift is noted in radiographs in which the medial clear space is greater than the superior joint space. Figure 2A is an intraoperative stress view of a Weber type B fracture showing widening of the medial clear space between the talus and the medial malleolus (Fig. 2B), versus that between the talus and the distal tibia.

• Diagnosis of syndesmosis disruption is based on AP and mortise view measurements taken at 1 cm above the ankle joint. On the AP view, there is less than 1 mm of tibia-fibula overlap and widening of the tibia-fibula clear space of greater than 4 mm (Fig. 3A). On the mortise view, there is less than 1 mm of tibia-fibula overlap (Fig. 3B).

• Figures 4–6 show the orientation of the foot and the skeleton when correctly positioned for radiographs in the AP (Fig. 4A and 4B), lateral (Fig. 5A and 5B), and mortise (Fig. 6A and 6B) views.

• The skeletal models seen in Figures 4–6 show the posterolateral position and areas of subchondral condensation of the fibula shown in Figure 1A.

• A sagittal CT scan highlights the marginal impaction (Fig. 7B).

• An axial CT scan shows the medial and lateral extents of impacted fragments and comminution of the subchondral bone (Fig. 7C).