Lauge-Hansen classification of ankle fractures (illustrations)
Lauge-Hansen classification
Supination adduction
transverse lateral malleolar fracture OR lateral collateral ligament rupture
add on vertical medial malleolar fracture
Supination external rotation
anterior inferior tibiofibular ligament rupture
add on lateral malleolus spiral fracture
add on posterior tibiofibular ligament rupture OR posterior malleolar fracture
add on medial malleolar fracture OR deltoid ligament rupture
Pronation abduction
medial malleolus fracture OR deltoid ligament rupture
add on the rupture of syndesmosis OR posterior malleolar fracture
add on lateral malleolus oblique fracture
Pronation external rotation
medial malleolus avulsion fracture OR deltoid ligament rupture
add on anterior syndesmosis injury
add on oblique/spiral fibular fracture
add on posterior syndesmosis injury OR posterior malleolar fracture
Case Discussion
The Lauge-Hansen classification of ankle fractures follows a hierarchical structure that can be used to guide radiographic interpretation. For example, in an ankle radiograph demonstrating a spiral fracture of the fibular above the syndesmosis, the patient most likely has a pronation-external rotation injury (stage 4) and therefore has a high chance of a posterior injury component.
The system follows predictable injury patterns, can justify further investigation, and highlights the importance of accurate clinical details.
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