Weber B Low anterior, high posterior fracture plane 3 Add posterior tibiofibular ligament rupture or posterior malleolar fracture 4 Add medial malleolar fracture or deltoid ligament rupture Supination Adduction Medial compression, lateral traction forces 1 Lateral malleolus fracture Weber A 2 Add vertical medial malleolus fracture Pronation External rotation Deltoid ligament under stress in pronation. Okanobo, H. Page Views: 4, Home Lauge Hansen Classification of Ankle Fractures. No fracture 2 Add lateral malleolar fracture Weber B Low anterior, high posterior fracture plane 3 Add posterior tibiofibular ligament rupture or posterior malleolar fracture 4 Add medial malleolar fracture or deltoid ligament rupture Supination Adduction Medial compression, lateral traction forces 1 Lateral malleolus fracture Weber A 2 Add vertical medial malleolus fracture Pronation External rotation Deltoid ligament under stress in pronation.
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These fractures are identical to the fractures described by Lauge-Hansen as supination-adduction, supination-exorotation and pronation-exorotation. We will first give a short overview of these fractures and then discuss them in more detail. Once you understand the trauma mechanism as described by Lauge-Hansen and the sequence of events that take place in stages, then you know where to look for fractures and ligamentous injuries.
Occurs below the syndesmosis, which is intact. According to Lauge-Hansen, it is the result of an adduction force on the supinated foot. Scroll through the images. Notice that the fibular fracture is transverse, because it is an avulsion or pull-off fracture. The tibial fracture is vertical or oblique, because it is a push-off fracture.
This is a transsyndesmotic fracture with usually partial - and less commonly, total - rupture of the syndesmosis. According to Lauge-Hansen, it is the result of an exorotation force on the supinated foot. Notice the oblique or vertical orientation of the push-off fibular fracture. This is a fracture above the level of the syndesmosis.
Usually there is a total rupture of the syndesmosis with instability of the ankle. According to Lauge-Hansen, it is the result of an exorotation force on the pronated foot. Weber A fractures are usually not a problem. Weber B and C are more difficult and it is essential to understand the sequence of events in these injuries, which are both exorotation injuries. Another important thing to remember is, that a ligament can rupture or cause an avulsion fracture at the insertion.
Every ligamentous rupture has it's avulsion fracture counterpart. In daily practice most use the Weber system, which is easy to memorize, while the Lauge-Hansen seems rather difficult at first glance.
Combining the simplicity of Weber with the explanation of the trauma mechanism given by Lauge-Hansen has the advantage that you still use a simple system, but now you really know what is going on. For instance if you see a fracture that is a stage 2 in the Lauge-Hansen system, then you know that there also is a stage 1 injury and you will study the radiographs with a high suspicion for signs of stage 3 and 4.
Additional radiographs of the lower extremity were ordered and they demonstrate a high fibular fracture, i. Weber C stage 3 also known as a Maisonneuve fracture.
This example is an every day case. The point that I want to make is, that when you understand the sequence of injuries to the ankle, then you know where to look for fractures and soft tissue swelling indicating ligamentous injury.
The diagnosis as well as the treatment is usually no problem. According to Lauge-Hansen the fracture results from an adduction force on the supinated foot. The lateral side is under extreme tension with stretch on the ligaments which results in an avulsion fracture.
Almost always the avulsion is seen as a horizontal fracture. This is called a pull off type of fracture in contrast to a push off type, which is seen as an oblique or vertical fracture. The images show the usual Weber type A fractures. These are all stage-1 fractures. Stage-2 is extremely uncommon.
Notice the horizontal orientation of the fracture lines. These are pull off type fractures as a result of avulsion. Stage 2 is uncommon and easy to detect. More adduction force results in the medial malleolus being pushed off in a vertical or oblique way. Stage 2 is unstable because the ring of the ankle is broken in two places.
Notice the horizontal orientation of the lateral malleolus fracture and the vertical orientation of the fracture of the medial malleolus. Enormous forces must have pushed off the medial malleolus. According to Lauge-Hansen the fracture results from an exorotation force on the supinated foot.
Stage 1 is usually not visible on x-rays. What we normally see is a stage 2 oblique fracture through the syndesmosis and we have to assume that there is also a rupture of the anterior tibiofibular ligament, which is stage 1.
According to Lauge Hansen the first injury is on the lateral side, which is under maximum tension. In stage 2 the talus exorotates further and since the foot is in supination, the lateral malleolus is held tightly in place by the lateral collateral ligaments. The lateral malleolus cannot move away without breaking. As a result more rotation of the talus will fracture the fibula in an oblique or spiral fashion because the lateral malleolus is pushed off from anteromedially to posterolaterally.
The images show a Weber B fracture. The oblique course of the fracture is typical for Weber B and results from the exorotation of the talus that pushes against the fixed lateral malleolus. The malleolar fracture usually starts medially at the level of the talar dome, but can also start a few centimeters above this level. Stage 3 More posterior displacement of the lateral malleolus fragment by the talus results in tension on the posterior syndesmosis with rupture or avulsion of the posterior malleolus.
Stage 4 Further posterior movement of the talus will result in extreme tension on the medial side and the deltoid ligament will either rupture or pull off the medial malleolus in the transverse plane. The sequences in a Weber B fracture or Lauge-Hansen supination exorotation injury take place in a clockwise manner:. Immediately after the injury the injured parts may again align, which can make it difficult to detect the injuries. The radiographs show a typical Weber B fracture.
First study the images and then continue reading. Do you see what stage this is? These images show another typical Weber B fracture stage 4. There is an oblique fracture of the fibula. There is an avulsion of the posterior malleolus and an avulsion of the medial malleolus.
Here another typical Weber B fracture stage 4. First notice the oblique fibular fracture, which is best seen on the lateral view. This is stage 2 and we have to assume, that the anterior syndesmosis is ruptured. On the lateral view a small tertius fragment is seen indicating stage 3.
Now you start looking for stage 4 and you will notice the subtle lucency in the medial malleolus on the AP view green arrow. Knowing the stages of Lauge Hansen this must be a fracture. Here a more subtle case. At first impression there is a Weber B fracture stage 2. Now we start looking for stage 3, which is a tertius fracture. The small linear density on the AP-view is enough to diagnose a tertius fracture. The soft tissue swelling on the medial side is probably a rupture of the medial collateral band , i.
It is the most difficult fracture to diagnose and the Lauge-Hansen system will help you to understand the fracture-mechanism, as this will be an enormous help. According to Lauge-Hansen the fracture results from an exorotation force on the pronated foot.
Stage 1 The first injury will occur on the medial side, which is under maximum tension due to the pronation. It will lead to rupture of the medial collateral ligament or avulsion of the medial malleolus. Now the injury can stop and there will only be a rupture of the medial collateral ligaments or avulsion of the medial malleolus. Lauge Hansen calls this PE stage 1. We can not cathegorize this in the Weber classification, since there is no fibular fracture. In many cases the injury progresses to a higher stage.
The talus rotates externally and moves laterally because it is free from its medial attachment. Due to the pronation, the lateral ligaments are not under tension and the fibula can move away from the tibia. This causes rupture of the anterior syndesmosis. This is stage 2. Continuous force will twist the fibula and displace it distally, while proximally it is fixed to the tibia.
Finally the interosseus membrane will rupture up to the point where the fibular shaft fractures. This is stage 3. This is always above the level of the syndesmosis. In many cases it is visible on the radiographs of the ankle, but in some cases the fracture is located high and will only be visible on a radiograph of the lower leg.
This last type of fracture is also called Maisonneuve fracture. The radiographs shows a Weber C fracture. There is an avulsion fracture of the medial malleolus and a fibula fracture above the level of the syndesmosis. According to Lauge-Hansen this is stage 3 pronation exorotation injury and so the anterior syndesmosis stage 2 must also be ruptured. We do not see a tertius fracture, which would indicate stage 4, but there may be a rupture of the posterior syndesmosis.
Here an example of a Weber C fracture with a proximal fibula fracture. Notice that on the radiograph of the ankle no fracture is seen. You might misdiagnose this as only some soft tissue swelling.
In fact this is an unstable ankle fracture, since there also must be a rupture of the medial collateral ligament stage 1 , so the ring is broken in two places leading to instability. Finally the posterior syndesmotic ligament ruptures, or there is an avulsion of the posterior malleolus, also known as posterior malleolus fracture red arrow. The medial clear space is only slightly widened, but based on the stages of Lauge Hansen there must be a collateral band rupture.
Lauge Hansen Classification of Ankle Fractures
These fractures are identical to the fractures described by Lauge-Hansen as supination-adduction, supination-exorotation and pronation-exorotation. We will first give a short overview of these fractures and then discuss them in more detail. Once you understand the trauma mechanism as described by Lauge-Hansen and the sequence of events that take place in stages, then you know where to look for fractures and ligamentous injuries. Occurs below the syndesmosis, which is intact. According to Lauge-Hansen, it is the result of an adduction force on the supinated foot. Scroll through the images.
Lauge-Hansen classification of ankle injury
The Lauge-Hansen classification is a system of categorizing ankle fractures based on the foot position and the force applied. From Wikipedia, the free encyclopedia. Method to classify an ankle fracture. Retrieved 27 October Categories : Bone fractures Ankle fracture classifications Injuries of ankle and foot Orthopedics stubs. Hidden categories: Articles with short description All stub articles.
The Lauge-Hansen classification system is used for the classification of the ankle injuries based on injury mechanisms which have predictable patterns and imaging findings. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Updating… Please wait. Unable to process the form.