{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:09:34Z","timestamp":1790078974958,"version":"4.0.1"},"reference-count":18,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: The diagnosis of syndesmotic instability remains challenging, particularly in quantifying posterior fibular translation. This study aimed to assess the Lateral Tibiofibular Index (LTI), a novel lateral projection\u2013based parameter, using standardized projections derived from three-dimensional computed tomography (3D CT) models. Methods: This retrospective simulation study included 80 adults (160 ankles; 40 women and 40 men; mean age, 42.7 \u00b1 12.4 years). Native 3D models were used to generate standardized lateral projections, after which isolated posterior fibular translations of 1 mm and 2 mm were simulated. Three linear parameters (A, B, C) were defined based on fixed anatomical landmarks. The LTI was calculated using the formula (A + B)\/(B + C). Four ratio-based candidate indices were evaluated. Receiver operating characteristic (ROC) analyses used participant-level clustered resampling to account for bilateral and repeated observations. Results: Mean LTI increased from 1.306 \u00b1 0.099 in native ankles to 1.406 \u00b1 0.109 after 1 mm translation and 1.515 \u00b1 0.121 after 2 mm translation. The LTI showed an area under the curve (AUC) of 0.756 (95% confidence interval [CI], 0.727\u20130.793) for native versus 1 mm translation and 0.916 (95% CI, 0.885\u20130.946) for native versus 2 mm translation. Youden-derived thresholds were 1.357 (sensitivity, 67.5%; specificity, 74.4%) and 1.381 (sensitivity, 89.4%; specificity, 80.6%), respectively. Conclusions: The LTI showed promising simulation-based discrimination of native anatomy from controlled posterior fibular translation, particularly at 2 mm. An LTI of approximately 1.50 should be regarded as a provisional upper reference value rather than a validated diagnostic cut-off. Prospective clinical studies in patients with confirmed syndesmotic injury are needed to further evaluate the diagnostic and intraoperative applicability of this parameter.<\/jats:p>","DOI":"10.3390\/jcm15187262","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:09:35Z","timestamp":1790075375000},"page":"7262","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Lateral Tibiofibular Index for Simulated Posterior Fibular Translation: A Three-Dimensional CT Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8984-9008","authenticated-orcid":false,"given":"O\u011fuzhan","family":"Tano\u011flu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Izmir Democracy University, 35140 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6150-9300","authenticated-orcid":false,"given":"Hamit \u00c7a\u011flayan","family":"Kahraman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, 34752 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e326","DOI":"10.1097\/BOT.0000000000000296","article-title":"Can we tell if the syndesmosis is reduced using fluoroscopy?","volume":"29","author":"Koenig","year":"2015","journal-title":"J. Orthop. Trauma"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: A review","volume":"37","author":"Caesar","year":"2006","journal-title":"Injury"},{"key":"ref_3","first-page":"123","article-title":"The evaluation of radiological measurements used in diagnosis and treatment of syndesmosis injury: A regional study in Turkey","volume":"31","author":"Polat","year":"2020","journal-title":"Jt. Dis. Relat. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/BOT.0b013e3181b1542c","article-title":"Outcome after unstable ankle fracture: Effect of syndesmotic stabilization","volume":"24","author":"Egol","year":"2010","journal-title":"J. Orthop. Trauma"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6054021","DOI":"10.1155\/2018\/6054021","article-title":"Medium-long-term radiographic and clinical outcomes after surgical treatment of intra-articular tibial pilon fractures by three different techniques","volume":"2018","author":"Biz","year":"2018","journal-title":"Biomed. Res. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/BOT.0b013e31826623cc","article-title":"APTF: Anteroposterior tibiofibular ratio, a new reliable measure to assess syndesmotic reduction","volume":"27","author":"Grenier","year":"2013","journal-title":"J. Orthop. Trauma"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1002\/ksa.70066","article-title":"Weight-bearing computed tomography volumetric analysis for diagnosis of syndesmotic instability: A new standard of care?","volume":"34","author":"Karaismailoglu","year":"2026","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1002\/jor.25049","article-title":"Volume measurements on weightbearing computed tomography can detect subtle syndesmotic instability","volume":"40","author":"Bhimani","year":"2022","journal-title":"J. Orthop. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1097\/CORR.0000000000002171","article-title":"Can weightbearing cone-beam CT reliably differentiate between stable and unstable syndesmotic ankle injuries? A systematic review and meta-analysis","volume":"480","author":"Raheman","year":"2022","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1002\/jmrs.589","article-title":"Which test is the best? An updated literature review of imaging modalities for acute ankle diastasis injuries","volume":"69","author":"Ng","year":"2022","journal-title":"J. Med. Radiat. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e250065","DOI":"10.1148\/rg.250065","article-title":"Distal tibiofibular syndesmosis: Anatomy, biomechanics, imaging approach, and postoperative evaluation","volume":"46","author":"Morimoto","year":"2026","journal-title":"Radiographics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1503\/cjs.004214","article-title":"Radiographic evaluation of the ankle syndesmosis","volume":"58","author":"Croft","year":"2015","journal-title":"Can. J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1097\/BOT.0b013e3182535f30","article-title":"Normal tibiofibular relationships at the syndesmosis on axial CT imaging","volume":"26","author":"Dikos","year":"2012","journal-title":"J. Orthop. Trauma"},{"key":"ref_14","first-page":"23","article-title":"Tibiofibular relationships of the normal syndesmosis on axial computed tomography in the Turkish population","volume":"114","author":"Bozlar","year":"2024","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_15","first-page":"53","article-title":"An inverse kinematic algorithm for the human leg","volume":"54","year":"2016","journal-title":"J. Theor. Appl. Mech."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.2174\/1573405617666210806150938","article-title":"Is proximal tibia sufficient for accurate measurement of tibial slope angles on three-dimensional tomography-based anatomical models?","volume":"17","year":"2021","journal-title":"Curr. Med. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1177\/107110079701800602","article-title":"Observer reliability in ankle radiographic measurements","volume":"18","author":"Brage","year":"1997","journal-title":"Foot Ankle Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/j.fas.2021.10.003","article-title":"The use of intraoperative comparative fluoroscopy allows for assessing sagittal reduction and predicting syndesmosis reduction in ankle fractures","volume":"28","author":"Abarca","year":"2022","journal-title":"Foot Ankle Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7262\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:27:35Z","timestamp":1790076455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7262"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":18,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187262"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187262","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]}}}