Trimalleolar ankle fracture - Lauge-Hansen PER IV

Case contributed by Henry Knipe
Diagnosis certain


"Inversion injury."

Patient Data

Age: 40 years
Gender: Male

Moderate displaced medial malleolar fracture. Mildly displaced posterior malleolus fracture. Mildly displaced oblique distal fibular shaft fracture. 

Case Discussion

This fracture pattern relates to the Lauge-Hansen PER stage IV classification. PER is pronation external rotation, so an eversion injury rather than inversion. 

Horizontal beam projections are useful if the patient has limited mobility, however, they can effectively reduce any lateral talar shift/syndesmotic widening if the lateral malleolus is placed on the bed. 

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