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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Stage 2 is unstable because the ring of the ankle is broken in two places. This impression will direct you to both a Weber as well as a Lauge-Hansen classification.
Lauge-Hansen classification – Wikipedia
This is a transsyndesmotic fracture with usually partial – and less commonly, total – rupture of the syndesmosis. Which of the following is unique with this particular ankle fracture pattern and must be recognized by the operating surgeon to optimize outcomes?
This also is shown because supination external rotation injuries often involve disruption of the deltoid ligament, which in a supinated foot would be under compression and unlikely to tear.
In daily practice most use the Weber system, which is easy to memorize, while the Lauge-Hansen seems rather difficult at first glance.
Notice the oblique or vertical orientation of the push-off fibular fracture. Foot fractures in restrained front seat car occupants: Occurs below the syndesmosis, which is intact. Injury patterns isolated medial malleolus fracture isolated lateral malleolus fracture bimalleolar and bimalleolar-equivalent fractures posterior malleolus fractures Bosworth fracture-dislocations open ankle fractures associated syndesmotic injuries isolated syndesmosis injury.
Supination adduction injuries occurred in eight experiments and consisted of two stages. Pronation – Abduction PA.
Pronation- weight on medial foot. Weber A fractures are usually not a problem. 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 classifocation Supination Adduction Medial compression, lateral traction forces 1 Lateral malleolus coassification Weber A 2 Add vertical medial malleolus fracture Pronation External rotation Deltoid ligament under stress in pronation.
These are pull off type fractures as a result of avulsion. No fracture 2 Add lateral malleolar fracture 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.
J Foot Ankle Surg. The soft tissue swelling on the medial side is probably a rupture of the medial collateral bandi. Stage 2 – Oblique fracture of the medial malleolus. Do you see what stage this is?
Clin Orthop Relat Res. Example 1 Basic interpretation There is a medial malleolar fracture. Re-examination Look for stage 3 and stage 4. In an attempt to create a classification system that did not rely on the mechanism of injury, which rarely is truly known and often speculated, Danis and Weber created an ankle fracture classification based on radiographic criteria.
On physical examination the patient is unable to feel a 5. Later investigators have been unable to duplicate the mechanical events or injuries described by Lauge-Hansen. Comparing radiographs with corresponding MR images of 51 ankle fractures, Hermans et al.
Purpose An ideal fracture classification would classificaton reproducible, widely recognized, relevant for prognosis, and useful in terms of clinical decision-making, documentation, and research. What we normally see is a stage 2 oblique fracture through the syndesmosis and we have to assume that there is also a rupture of the anterior tibiofibular ligament, which is stage 1.
Lauge Hansen Classification of Ankle Fractures
We will first give a short overview of these fractures and then discuss them in more detail. Which of the bone fragments labeled on the distal tibia in the axial CT scan shown in Figure A is attached to lwuge posterior tibiofibular ligament? Is this a case of a simple lateral malleolus fracture? The point that I want to make is, that when you understand the sequence of injuries to the ankle, then you know where to look for fractures and soft tissue swelling indicating ligamentous injury.
Supination was comprised of internal rotation of the ankle about the tibial axis, forefoot adduction, and hindfoot inversion; pronation was made up of external rotation of the ankle about the tibial axis, forefoot abduction, and hindfoot eversion. Recommended management should consist of? At reexamination you notice the subtle avulsion of the medial malleolus red arrowwhich is stage 1. One of the keys to the Lauge-Hansen classification is the geometry of the hasen malleolus fracture.
Notice that all 4 stages are visible: These images show another typical Weber B fracture stage 4. Observer variation in the radiographic classification of ankle fractures.