Lauge-Hansen classification of ankle injury

Description

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 ] [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

History of the Lauge-Hansen classification

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)

1972 – Bernhard Georg Weber developed and popularised the Danis-Weber classification system most commonly used in practice today

The Lauge-Hansen classification system was developed based on a cadaveric study which included imprecise replication of the true pathobiomechanics encountered during ankle fracture and incorporated deduced concepts like foot position at the time of injury and direction of the deforming force

Lauge-Hansen’s original methodology required manipulation and the application of forces by hand to a fixed foot. This was deemed to be imprecise and failing to accurately recreate the in vivo forces experienced by a patient while sustaining an ankle fracture. Studies were undertaken to review the combination of axial load and rotational forces as the body moves relative to a foot planted on the ground. 

2010/2013 – Kwon, Rodriguez et al studied YouTube videos and correlated mechanisms of injury with radiographic findings. They found that when injury video clips were matched to their corresponding X-rays, the Lauge-Hansen classification system had a 65% (17 of 26 ankle fractures) consistency rate in predicting fracture patterns from the deforming-injury mechanism. However the AO/OTA classification system had an improved consistency rate of 81% (21 of 26 ankle fractures)

Associated Persons

• Niels Lauge-Hansen (1899-1976) [Lauge-Hansen classification]
• Robert Danis (1880-1962) [Danis-Weber classification]
• Bernhard Georg Weber (1927-2002) [Weber classification]

References

Original articles

• 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.

Review articles

• 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.
• Kwon JY, Chacko AT, Kadzielski JJ, Appleton PT, Rodriguez EK. A novel methodology for the study of injury mechanism: ankle fracture analysis using injury videos posted on YouTube.com. J Orthop Trauma. 2010 Aug;24(8):477-82.
• Rodriguez EK, Kwon JY, Herder LM, Appleton PT. Correlation of AO and Lauge-Hansen classification systems for ankle fractures to the mechanism of injury. Foot Ankle Int. 2013; 34: 1516-1520.
• 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
• Knipe H. Lauge-Hansen classification of ankle injury. Radiopaedia
• Eponymythology: Eponymous ankle and talus injuries. LITFL

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