LAUGE HANSEN CLASSIFICATION IN ANKLE FRACTURES
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ankle fractures classification
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Lauge Hansen classification ankle fractures supination external rotation stages reliable orthopaedic reference
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Lauge Hansen ankle fracture classification diagram supination external rotation pronation external rotation stages
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https://pmc.ncbi.nlm.nih.gov/articles/PMC4562928/
Lauge-Hansen classification of ankle fractures
A mechanism-based classification. It uses:
- Foot position at the time of injury: supination or pronation
- Direction of deforming force: adduction, external rotation, or abduction
The stages represent a predictable sequence of progressive ligament and bone injury.
| Type | Injury sequence | Typical fibular level |
|---|---|---|
| SER: Supination-external rotation | 1. AITFL injury 2. Oblique/spiral distal fibular fracture 3. PITFL injury or posterior malleolus fracture 4. Deltoid rupture or medial malleolus fracture | Weber B, at syndesmosis |
| SAD: Supination-adduction | 1. Transverse distal fibular fracture or lateral ligament avulsion 2. Vertical medial malleolus fracture, sometimes with medial tibial plafond impaction | Weber A, below syndesmosis |
| PER: Pronation-external rotation | 1. Deltoid rupture or medial malleolus fracture 2. AITFL injury 3. Spiral/oblique fibular fracture above syndesmosis 4. PITFL injury or posterior malleolus fracture | Weber C, above syndesmosis |
| PAB: Pronation-abduction | 1. Deltoid rupture or transverse medial malleolus fracture 2. Syndesmotic injury, particularly AITFL 3. Transverse or comminuted fibular fracture at or above syndesmosis | Usually Weber C |
Key points for exams
- Most common pattern: SER.
- SER fracture line: short oblique or spiral distal fibular fracture, running anteroinferior to posterosuperior.
- PER injury: starts medially, then progresses through the syndesmosis to a high fibular fracture. Examine the whole fibula for a possible Maisonneuve injury.
- SAD injury: produces a characteristic vertical medial malleolar fracture.
- A posterior malleolar fracture is typically a late injury in SER or PER patterns.
- The classification helps predict occult ligament and syndesmotic injuries, but its observer agreement is imperfect. In current practice it is generally used alongside radiographic assessment of mortise congruity, syndesmotic stability, and fracture morphology.
Mnemonic:
- Supination injuries start lateral
- SAD: lateral fibula, then medial malleolus
- SER: AITFL, fibula, posterior structures, then medial side
- Pronation injuries start medial
- PER/PAB: medial side first, then syndesmosis/fibula
This system describes the foot position and deforming force, rather than simply the level of fibular fracture. Rockwood and Green's Fractures in Adults, 10th ed., p. 3296. A useful review of the classification summarizes the classic staged patterns and limitations.
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