The mortise ankle view for pediatrics is one of three views to examine the distal tibia, distal fibula, proximal talus and proximal fifth metatarsal. Depending on the child's age and the departmental protocol, the mortise view may or may not be performed.
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Terminology
Mortise and mortice are variant spellings and equally valid 1.
Indications
This projection demonstrates the mortise joint, particularly the lateral border of the mortise. It is useful for diagnosing fractures; particularly distal fibular fractures, joint space abnormalities and localizing foreign bodies in pediatric patients.
Patient position
the patient is supine with their affected foot in slight dorsiflexion
leg is rotated internally 15° to 20° to align the 5th toe with the center of the calcaneum
Technical factors
anteroposterior projection
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centering point
the midpoint of the lateral and medial malleoli
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collimation
laterally to the skin margins
superior to examine the distal third of the tibia and fibula
inferior to the proximal aspect of the metatarsals
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orientation
portrait
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detector size
18 x 24 cm
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exposure 2
50-55 kVp
1-2 mAs
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SID
100 cm
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grid
no
Image technical evaluation
The entire mortise joint should be open with only slight superimposition of the distal tibiofibular joint 3. A physical metal marker is ideal for pediatric imaging.
Practical points
Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is important as pediatric patients may not remain still when their affected ankle is moved onto the detector.
Immobilization techniques
It is important for the radiograph to be free from motion artifact and rotation to avoid repeated x-rays.
it may be necessary for the parent or radiographer to hold the patient in position
ideally the parent should be in the child's direct line of sight
techniques will vary based on the department
distraction techniques can be utilized to avoid scattered radiation to parents and staff 4
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