Lauge-Hansen Classification

Last updated: July 6, 2026Reviewed date: July 6, 2026Reading time: 5 min read

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The Lauge-Hansen classification system is used to identify, investigate the severity, a risk factor for the classification of ankle injuries based on injury mechanisms that have predictable patterns and imaging findings. Along with the Weber classification, these systems are useful tools for describing and classifying ankle injuries. Classification The Lauge-Hansen system uses two-word descriptors: the first word describes the position of the foot at the time...

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Definition

The Lauge-Hansen classification system is used to identify, investigate the severity, a risk factor for the classification of ankle injuries based on injury mechanisms that have predictable patterns and imaging findings. Along with the Weber classification, these systems are useful tools for describing and classifying ankle injuries.

Classification

The Lauge-Hansen system uses two-word descriptors:

the first word describes the position of the foot at the time of injury (i.e. supination or pronation)
the second word describes the deforming force direction (i.e. abduction, adduction, or external rotation)

Based on these two factors, at least 13 different patterns have been described:

supination-adduction
- without medial malleolar fracture (Weber A)
- with oblique or vertical medial malleolar fracture
supination-external rotation: the most common form of injury (40-70%)
- stage 1: the anteroinferior tibiofibular ligament is torn or avulsed
- stage 2: the talus displaces and fractures the fibula in an oblique or spiral fracture, starting at the joint (Weber B)
- stage 3: tear of the posteroinferior tibiofibular ligament or fracture posterior malleolus
- stage 4: tear of the deltoid ligament or transverse avulsion fracture medial malleolus
pronation-abduction
- stage 1: deltoid ligament disruption or transverse medial malleolus fracture
- stage 2: posterior malleolus fracture
- stage 3: oblique fibular fracture (Weber C)
pronation-external rotation
- stage 1: deltoid ligament rupture, which may appear occult or as medial mortise widening, or transverse avulsion fracture of the medial malleolus
- stage 2: involvement of the AITFL with extension into the interosseous membrane results in widening of the distal tibiofibular distance
- stage 3: a spiral or oblique fibular fracture (>6 cm) above the talotibial joint (Weber C)
- stage 4: involvement of the posterior inferior tibiofibular ligament (PITFL), or posterior malleolus fracture

Categories and stages of the Lauge-Hansen classification system

Category	Stage
Supination external rotation	1 Injury of the anterior inferior tibiofibular ligament
	2 Oblique/spiral fracture of the distal fibula
	3 Injury of the posterior inferior tibiofibular ligament or avulsion of the posterior malleolus
	4 Medial malleolus fracture or injury to the deltoid ligament
Supination adduction	1 Transverse fracture of the distal fibula
Supination adduction	2 Vertical fracture of the medial malleolus
Pronation external rotation	1 Medial malleolus fracture or injury to the deltoid ligament
	2 Injury of the anterior inferior tibiofibular ligament
	3 Oblique/spiral fracture of the fibula proximal to the tibial plafond
	4 Injury of the posterior inferior tibiofibular ligament or avulsion of the posterior malleolus
Pronation abduction	1 Medial malleolus fracture or injury to the deltoid ligament
	2 Injury of the anterior inferior tibiofibular ligament
	3 Transverse or comminuted fracture of the fibula proximal to the tibial plafond

Lauge-Hansen Classification

References

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Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

Write when the problem started and how it changed.
Bring old prescriptions, investigation reports, and current medicines.
Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

What is the most likely cause of my symptoms?
Which danger signs mean I should go to hospital quickly?
Which tests are necessary now, and which can wait?
How should I take medicines safely and what side effects should I watch for?
When should I come for follow-up?

Tests to discuss

Vital signs: temperature, pulse, blood pressure, oxygen saturation
Basic physical examination by a clinician
CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

Rest, drink safe water, and observe symptoms carefully.
Keep a written note of symptoms, duration, temperature, medicines already taken, and allergy history.
Seek medical care quickly if symptoms are severe, worsening, or unusual for the patient.

OTC medicine safety

For mild pain or fever, ask a registered pharmacist or doctor before using common over-the-counter pain/fever medicines.
Do not combine multiple pain medicines without advice, especially if you have kidney disease, liver disease, stomach ulcer, asthma, pregnancy, or take blood thinners.
Do not give adult medicines to children unless a qualified clinician advises it.

Avoid these mistakes

Do not start antibiotics without a proper medical decision.
Do not use steroid tablets or injections casually for quick relief.
Do not delay emergency care because of home remedies.

Get urgent help if

Severe symptoms, confusion, fainting, breathing difficulty, chest pain, severe dehydration, or sudden weakness need urgent medical care.

Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider

Tests to discuss with doctor

Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
Relevant blood, urine, imaging, or specialist tests only after clinical assessment

Questions to ask

What is the most likely cause of my symptoms?
Which warning signs mean I should go to emergency care?
Which tests are really needed now?
Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Go to emergency care if you notice:

Severe or rapidly worsening symptoms
Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration

Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.

Step 1
Check danger signs first

If danger signs are present, seek emergency care and do not wait for online information.
Step 2
Record the symptom story

Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.
Step 3
Visit a qualified clinician

A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.
Step 4
Do only useful tests

Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.
Step 5
Follow up and return early if worse

If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips

Take a written symptom diary and all previous prescriptions/test reports.
Do not hide medicines already taken, even herbal or over-the-counter medicines.
Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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