Lauge-Hansen’s classification, which was published in a issue of Archives of Surgery, has become one of the most widely used ankle. The Lauge-Hansen classification is a system of categorizing ankle fractures based on the foot position and the force applied. Classification, Description, Notes. Supination External Rotation, Most common mechanism (% of all fractures). 1, Anterior tibiofibular ligament rupture.
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Interobserver and intraobserver reliabilities are fair at best for the Lauge-Hansen classification. Received Jan 7; Accepted Apr 9. This causes rupture of the anterior syndesmosis. At reexamination you notice the subtle avulsion of the medial malleolus red arrowwhich is stage 1.
Radiographs from the ER are provided in figures A and B. Medial malleolus transverse fracture or disruption of deltoid ligament Anterior tibiofibular ligament sprain Transverse comminuted fracture of the fibula above the level of the syndesmosis.
Lauge-Hansen classification of ankle injury • LITFL Medical Blog • Eponym
Fibular plating with open correction of plafond impaction with medial malleolar antiglide plate. Weber B Low anterior, high posterior fracture plane 3 Add posterior tibiofibular ligament rupture or posterior malleolar fracture 4 Add medial malleolar fracture or deltoid ligament rupture Supination Adduction Medial compression, lateral traction forces 1 Lateral malleolus fracture Weber A 2 Add vertical medial malleolus fracture Pronation External rotation Deltoid ligament under stress in pronation.
Looking at the classification system When we look at the scheme we will notice that a fracture of the posterior malleolus in most cases is part of a Weber B or a Weber C fracture. This was the impetus for the work of Niel Lauge-Hansen —a Danish physician who studied ankle fractures during the s and s, ultimately creating a classification system based on a rotational mechanism of injury [ 11 — 15 ].
Supination – External rotation. For each combination of foot position and deforming force, a consistently reproducible fracture pattern was elucidated. Stage 2 Stage 2 is uncommon and easy to detect. Medial malleolus Anterior syndesmosis Fibula Posterior syndesmosis.
The sequences in a Weber B fracture or Lauge-Hansen supination exorotation injury take place in a clockwise manner: TartaglioneMD, Andrew J. Studies have shown that a small percentage of ankle fractures, such as isolated fractures of the posterior tibial margin, do not fit into the Lauge-Hansen classification [ 528 ].
In daily practice most use the Weber system, which is easy to memorize, while the Lauge-Hansen seems rather difficult at first glance.
We do not see a tertius fracture, which would indicate stage 4, but there may be a rupture of the posterior syndesmosis. Stage-2 is extremely uncommon. This is always above the level of the syndesmosis. Retrieved 27 October Normally you probably would not have noticed these.
Classifications in Brief: Lauge-Hansen Classification of Ankle Fractures
The ankle circle is interrupted at two places i. Danis-Weber Type C fractures can be associated with medial malleolus fractures or injury to the deltoid ligament.
Ankle fractures are common musculoskeletal injuries that occur in a bimodal distribution, with peaks in younger men and older women [ 2 ], the former related to high-energy trauma and the latter to osteopenia and osteoporosis. In what direction is the fibula most unstable? Avulsion fracture of the medial malleolar. How would you manage this patient given she is now 3 months from the injury? Comparing radiographs with corresponding MR images of 51 ankle fractures, Hermans et al.
For interobserver agreement, the mean kappa value was 0. Although still considered a landmark work regarding the biomechanics and deforming forces of ankle fractures, the quality, validity, and reproducibility of the Lauge-Hansen classification have been challenged [ 17192225 ]. The talus rotates externally and moves laterally because it is free from its medial attachment. What is the most appropriate definitive treatment? Lauge-Hansen classification of malleolar fractures: In many cases the injury progresses to a higher stage.
Scroll through the images. Open reduction internal fixation of the fibula with syndesmosis reduction and suture-button repair. Ligamentous rupture or Avulsion Another important thing to remember is, that a ligament can rupture or cause an avulsion fracture at the insertion. Like the Danis-Weber classification, it is based only on radiographic criteria, in contrast to the Lauge-Hansen system, which unlike all other appendicular fracture classification systems, incorporates the mechanism of injury.
The images show a Weber B fracture.
CT scans note anteromedial marginal impaction. Correlation between radiological assessment of acute ankle fractures and syndesmotic injury on MRI. Rupture of the anterior syndesmosis – seen as widening of the space between the distal tibia and fibula lateral clear space.
Biomechanics deltoid ligament deep portion primary restraint to anterolateral talar displacement fibula acts as buttress to prevent lateral displacement of talus.
Ankle Fractures – Trauma – Orthobullets
Stage 2 – Oblique fracture of the medial malleolus. Weber B This is a transsyndesmotic fracture with usually partial – and less commonly, total – rupture of the syndesmosis.
Usually there is a total rupture of the syndesmosis with instability of the ankle. No fracture 2 Add lateral malleolar cpassification Weber B Low anterior, high posterior fracture plane 3 Add posterior tibiofibular ligament rupture or posterior malleolar fracture 4 Add medial malleolar fracture or deltoid ligament rupture Supination Adduction Medial compression, lateral traction forces 1 Lateral malleolus fracture Weber A 2 Add vertical medial malleolus fracture Pronation External rotation Deltoid ligament under stress in pronation.
What is the most reliable method to evaluate the competence of the deltoid ligament?
Of the following options, what would be the recommended treatment? L8 – 10 years in practice. Oblique fibula fracture at the level of the syndesmosis – i. With more force, the posterior inferior tibiofibular ligament PITFL was injured or claswification posterior malleolus was fractured in Stage 3.