Presentation
Ankle osteoarthritis. Benefit from previous ankle injection.
Patient Data
In a right lateral position, pre-procedure fluoroscopy optimized orientation to obtain a true lateral ankle projection. The dorsalis pedis pulse was palpated then followed and marked proximally. Small amount of 1% lidocaine to skin. Targeting the anterior ankle joint and using a 25 gauge 40mm needle with an 'off-plane' technique the joint was cannulated. Injection of iodinated contrast confirms an intra-articular position.
2.5ml of a steroid containing injectate administered.
For ankle joint injections with the patient in a lateral position, a true lateral projection is desired. When positioning, the focus should be on the fibula which should be at or close to the central aspect of the tibia. The same positioning can be used when injecting the posterior subtalar joint under fluoroscopy.
Case Discussion
Ankle joint injections are performed under fluoroscopy using an anterior approach to the joint, with the patient in a lateral position or supine 1. The lateral position is felt advantageous to some, as it more accurately reflects the amount of injectate given. Spending time positioning pre-procedure will help with the time spent on the procedure itself.