Lauge-Hansen Classification

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.

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
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

References

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