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Contribution of Individual Projections Alone and in Combination for Radiographic Detection of Ankle Fractures

Eric A. Brandser1, Kevin S. Berbaum1, Donald D. Dorfman1, Robert J. Braksiek2, Georges Y. El-Khoury1, Charles L. Saltzman3,4, J. L. Marsh3 and William A. Clark1

1 Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52240.
2 College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52240.
3 Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52240.
4 Department of Biomedical Engineering, University of Iowa Hospitals and Clinics, Iowa City, IA 52240.



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  		Fig. 1A. —24-year-old man with ankle injury and fracture of medial malleolus. Anteroposterior radiograph shows oblique fracture (arrows) of medial malleolus.

 


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  		Fig. 1B. —24-year-old man with ankle injury and fracture of medial malleolus. Mortise view radiograph fails to show fracture as clearly as A. Only finding is subtle cortical interruption (arrow) at medial malleolus.

 


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  		Fig. 1C. —24-year-old man with ankle injury and fracture of medial malleolus. Lateral radiograph shows no fracture.

 


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  		Fig. 2A. —32-year-old man with trimalleolar fracture. Anteroposterior radiograph shows lateral malleolus fracture, but fractures of medial and posterior malleoli are not visible.

 


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  		Fig. 2B. —32-year-old man with trimalleolar fracture. Mortise view radiograph shows lateral malleolus fracture and also shows medial malleolus fracture (arrow) not seen in A but does not show posterior malleolus fracture.

 


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  		Fig. 2C. —32-year-old man with trimalleolar fracture. Lateral radiograph shows fractures of posterior and lateral malleoli, but medial malleolus fracture is not visible.

 


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  		Fig. 3. —Models for combining single radiographic view interpretations into two- and three-view combinations. Top row is for anteroposterior (AP) and lateral combination, middle row is for mortise and lateral combination, and bottom row is for three-view combination. Matrices show numeric value for a given subject on basis of confidence rating assigned by a rater on individual views. See Appendix for more detail.

 

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