The paediatric tibia fibula lateral view is part of a two-view series of the entire tibia, fibula, and both the knee and ankle joint. 

Indications

The tibia fibula lateral view is performed for evaluation of the lower leg in paediatric patients. It allows for assessment of fractures in trauma or suspicion of a foreign body or bone lesions, including osteomyelitis. If one is concerned about the ankle joint, the ankle series is more appropriate, if the knee is the point of focus, a knee series.

Patient position

• the patient is positioned in a lateral recumbent position

• lateral aspect of the affected leg should be in contact with the detector

• knee can be flexed or extended

• leave the unaffected leg behind the affected leg to prevent over rotation

Technical factors

• mediolateral projection 

• centring point

  • midpoint of the tibia

• collimation

  • laterally to the skin margins

  • superior to the knee joint

  • inferior to the ankle joint

• orientation

  • portrait or diagonal depending on limb length  

• detector size

  • 35 cm x 43 cm or 43 cm x 35 cm

• exposure 

  • 55-60 kVp

  • 1-2 mAs¹

• SID

  • 100 cm

• grid

  • no

Image technical evaluation

• tibia superimposes about half of the fibular head

• mid shaft of the fibular is free of superimposition from the tibia

• posterior portions of the distal tibia and fibula are aligned

• tibia and fibula are demonstrated in the lateral position in their entirety from the knee joint to the ankle

• knee and tibiotalar joint spaces are closed²

Practical points

Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is important as paediatric patients may not remain still when their affected leg is moved onto the detector. 

In some cases where the patient's limb does not fit in one image, it is better to take two images at both points than perform a sub-par projection in the centre. If both the ankle and the knee joints are not present it is not a complete series.

Immobilisation techniques

It is important to avoid repeated x-rays and for the radiograph to be free of motion artifact and rotation.

• 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 utilised to avoid scattered radiation to parents and staff ³