Lauge-Hansen classification of ankle injury

Last revised by Andrew Murphy on 02 Dec 2022

The Lauge-Hansen classification system is used for classifying ankle injuries based on injury mechanisms with predictable patterns and imaging findings. These systems are useful tools for describing and classifying ankle injuries along with the Weber 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 above the level of the joint, in a low medial high lateral fracture plane (Weber C) 1

  • 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 

The classification system is named after the Danish physician, Sir Niels Lauge-Hansen, who published several papers on ankle fracture mechanisms in the late 1940s and early 1950s 3.

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Cases and figures

  • Case 1: Lauge-Hansen PER IV
    Drag here to reorder.