The intermalleolar space is the distance between the medial and lateral malleoli that defines the width of the ankle mortise. The width is maintained by the integrity of the tibiofibular syndesmosis and deltoid ligament, and is measured radiographically as the medial clear space on mortise view X-ray.
The medial clear space on mortise view X-ray should be equal to or less than the superior clear space and normally does not exceed 4 mm. Medial clear space widening indicates deltoid ligament rupture or lateral displacement of the talus within the mortise. The intermalleolar space narrows in varus ankle deformity and widens in valgus. Accurate mortise restoration is the primary goal of ankle fracture fixation.
Increased medial clear space from deltoid ligament rupture or fibular shortening allowing lateral talar shift within the mortise, producing ankle instability requiring surgical restoration of the normal 4 mm medial clear space.
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