Broden's view

The Broden's view (or Broden view) is a specialized projection that accurately ¹ examines the large posterior calcaneal facet and the subtalar joint ².

As technology advances, computed tomography (CT) has widely been used to better visualize and characterize fragment displacements and fracture lines. Yet, there remain various reasons for plain film imaging being the choice modality, like inaccessibility or absence of a CT scanner in rural regions and the affordability of the scans for patients.

Depending on departmental protocol, one or four images at varying cephalic angles may be acquired to view different parts of the posterior calcaneal facet ³. The cephalic angles ⁴ recommended are at:

• 10°: demonstrates most posterior aspect
• 20°: default angle used if only one single image is allowed
• 30°
• 40°: demonstrates most anterior aspect

Indications

This view at varying angles aid in detecting potential fracture displacement, depression or subluxation of the hindfoot after a notable ²:

• axial loading mechanism (for intra-articular fractures)
• low energy mechanism (for extra-articular fractures)

Patient position

• patient is supine or seated with the affected limb extended 
• the posterior aspect of the ankle is resting on the image receptor 
• the affected leg must be rotated 45° internally
  • internal rotation must be from the hip; isolated inversion of the ankle will result in a non-diagnostic image
• foot should be in neutral dorsiflexion

Technical factors

• anteroposterior axial projection
• centering point
  • the beam is angled at 10°, 20°, 30° and 40° cephalad from the long axis of the foot
  • central ray is placed over the lateral malleolus ²
• collimation
  • lateral to the skin margins
  • superior to the distal third of tibia and fibula
  • inferior to the tarsals 
• orientation  
  • portrait
• detector size
  • 18 cm x 24 cm
• exposure
  • 55-60 kVp
  • 3-5 mAs
• SID
  • 100 cm
• grid
  • no

Image technical evaluation 

• clear visualization of the anterior and posterior talocalcaneal joint ⁵

Practical points

Although having the patient's foot in dorsiflexion is preferred, many times this will not be possible due to pain. In such scenarios, it is equally effective to:

• increase the cephalic angle to compensate for lack of dorsiflexion
• raise the distal part of the leg (placing an immobilization sponge underneath the leg), ensuring the knee joint is kept extended