Which projection best demonstrates the distal tibiofibular joint?

The 45-degree medial oblique projection is particularly effective in demonstrating the distal tibiofibular joint because it provides optimal visualization of the joint space and the relationship between the tibia and fibula. This projection allows the distal ends of the tibia and fibula to be rotated and separated, thus reducing overlapping bony structures.

In this position, the articular surface of the joint is clearly depicted, which is essential for assessing any joint pathology or abnormalities that may be present. Radiologists prefer this angle as it provides a better perspective on the joint compared to other projections, making it easier to identify any potential issues such as syndesmosis injuries, fractures, or any joint-space width changes.

Other projections, such as the 45-degree lateral oblique, AP projection, and AXR view, do not offer the same level of detail or clarity in visualizing the distal tibiofibular joint. While they may be useful for assessing different aspects of the ankle or surrounding structures, they do not focus on the joint itself in the same way that the medial oblique projection does. Thus, the 45-degree medial oblique is the most appropriate choice for this specific anatomical evaluation.