Niels Lauge-Hansen

Biography

• Born 1899
• Worked primarily at the Central Hospital, Randers, Denmark.
• 1942 – published his thesis ‘Genetisk Diagnose og Reposition’
• 1948 – published ‘Ankle fractures 1: the analytical historical survey’, providing a history of ankle fracture management since Hippocrates, forming the basis of his work.
• 1950 – used fresh cadaveric lower limb amputations, fixed with a vice and nails, to observe a spectrum of ankle injuries. These were demonstrated in force produced by hand to the hindfoot, and formed the basis of his publication ‘Ankle fractures 2: the combined experimental-surgical and experimental roentgenologic investigation’.
• 1952 – described how to perform closed ankle fracture reduction, based on reversal of injury mechanism, published in ‘Ankle fractures 4: clinical use of genetic roentgenologic diagnosis and genetic reduction’.
• 1954 – applied previous work to describe his radiographic classification and effect of rotational ankle force on interosseous clear space and mortise, publishing ‘Ankle fractures 3: the genetic roentgenologic diagnosis of fractures of the ankle’.
• 1959-1961 Worked in Seoul (South Korea), honorary member of the Korean Radiology Association
• Died in 1976.

Medical Eponyms

Lauge-Hansen classification of ankle fractures (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.

Controversies

Recent research using up to date experimental techniques, has failed to consistently reproduce Lauge-Hansen’s initial findings, questioning the reliability of his classification system. However, the value of his classification when considering concurrent soft tissue injuries, alongside fractures, remains in high regard.

Major Publications

• Lauge N. Fractures of the ankle; analytic historic survey as the basis of new experimental, roentgenologic and clinical investigations. Arch Surg. 1948 Mar;56(3):259-317.
• Lauge-Hansen N. Ligamentous ankle fractures; diagnosis and treatment. Acta Chir Scand. 1949 Mar 23;97(6):544-50.
• Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950 May;60(5):957-85.
• 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.
• Lauge-Hansen N. Fractures of the ankle. IV. Clinical use of genetic roentgen diagnosis and genetic reduction. AMA Arch Surg. 1952 Apr;64(4):488-500.
• Lauge-Hansen N. Fractures of the ankle. V. Pronation-dorsiflexion fracture. AMA Arch Surg. 1953 Dec;67(6):813-20.
• Lauge-Hansen N. Early roentgen diagnosis of spastic contraction ring in the uterus (Bandl’s ring) during labor and roentgenographic demonstration of the subcutaneous fat deposits of the fetus (the fat line) and of the placenta. Am J Roentgenol Radium Ther Nucl Med. 1955 Aug;74(2):315-22.
• Lauge-Hansen N. The Development and the Embryonic Anatomy of the Human Gastro-Intestinal Tract: a New Basis for the Study of Anomalies of the Gastro-Intestinal Tract. Eindhoven: Centrex Publishing Company, 1960

References

• Kwon JY, Gitajn IL, Walton P, Miller TJ, Appleton P, Rodriguez EK. A cadaver study revisiting the original methodology of Lauge-Hansen and a commentary on modern usage. J Bone Joint Surg Am. 2015;97:604-9.
• Shariff SS, Nathwani DK. Lauge-Hansen classification – a literature review. Injury. 2006;37(9):888-890.
• Michelson J, Solocoff D, Waldman B, Kendell K, Ahn U. Ankle fractures: The Lauge-Hansen classification revisited. Clin Orthop Relat Res. 1997;(345):198-205.
• Eponymythology: Eponymous ankle and talus injuries. LITFL