The Lauge-Hansen classification of ankle injuries was developed on the basis of predictable fracture patterns defined by injury mechanism and resultant radiological findings in 1950
Appreciation of ankle injury mechanism furthers understanding of likely associated ligamentous injury, implications of joint stability and management.
The Lauge-Hansen classification requires three radiographic views of the ankle (anteroposterior, mortise and lateral) and is characterised with specific two-word descriptors of the injury mechanism:
- First word: describes the position of the foot at the time of injury (supination or pronation)
- Second word: describes the deforming force direction (abduction, adduction, or external rotation)
Lauge-Hansen’s classification can be difficult to remember and best reviewed in comparison to the simplified Danis-Weber classification. Awareness of the injury mechanism, enhances interpretation and identification of subtle Lauge-Hansen injury stages.
Supination adduction [ =Weber A ]
- Stage 1: stress on lateral collateral ligaments results in ligament rupture or lateral malleolus avulsion fracture (below level of syndesmosis).
- Stage 2: oblique fracture of medial malleolus
Supination external rotation [ =Weber B ] [the most common injury mechanism]
- Stage 1: anterior syndesmosis rupture
- Stage 2: oblique fracture of lateral malleolus (at level of syndesmosis)
- Stage 3: posterior syndesmosis rupture or posterior malleolus avulsion fracture
- Stage 4: avulsion of medial malleolus or rupture of medial collateral ligaments (deltoid ligament)
Pronation external rotation (= Weber C)
- Stage 1: avulsion of medial malleolus or rupture of medial collateral ligaments (deltoid ligament)
- Stage 2: anterior syndesmosis rupture
- Stage 3: fibula fracture (above level of syndesmosis)
- Stage 4: posterior syndesmosis rupture or posterior malleolus avulsion
1948 – Lauge-Hansen published his first definitive review on ankle fractures and an analytical review on the history of ankle fractures used as the basis of his future experimental, roentgenologic and clinical investigation
1949 – Robert Danis published ‘Théorie et pratique de l’ostéosynthèse‘ providing early basis to classification
1950 – In ‘Fractures of the ankle II‘, Lauge-Hansen combined experiment surgical and roentgenologic investigations to provide the earliest description of his classification
1952 – Lauge-Hansen went on to publish ‘Fractures of the ankle IV: Clinical use of genetic roentgen diagnosis and genetic reduction’ (1952); ‘Fractures of the ankle V: Pronation-dorsiflexion fracture’ (1953) and ‘Fractures of the ankle III: Genetic roentgenologic diagnosis of fractures of the ankle’ (1954)
- Niels Lauge-Hansen (1899-1976) [Lauge-Hansen classification]
- Robert Danis (1880-1962) [Danis-Weber classification]
- Bernhard Georg Weber (1927-2002) [Weber classification]
- Lauge-Hansen N. Fractures of the ankle. III. Genetic roentgenologic diagnosis of fractures of the ankle. Am J Roentgenol Radium Ther Nucl Med. 1954 Mar;71(3):456-71.
- Okanobo H, Khurana B, Sheehan S, Duran-Mendicuti A, Arianjam A, Ledbetter S. Simplified diagnostic algorithm for Lauge-Hansen classification of ankle injuries. Radiographics. 2012 Mar-Apr;32(2):E71-84.
- Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures: an MRI study. J Orthop Trauma. 2006 Apr;20(4):267-72.
- Somford MP, Wiegerinck JI, Hoornenborg D, van den Bekerom MPJ. Ankle fracture eponyms. JBJS 2013; 95(24): e198
- Tartaglione JP, Rosenbaum AJ, Abousayed M, DiPreta JA. Classifications in Brief: Lauge-Hansen Classification of Ankle Fractures. Clin Orthop Relat Res. 2015 Oct;473(10):3323-8
- Eponymythology: Eponymous ankle and talus injuries. LITFL
the names behind the name