Ankle Fractures — Lauge-Hansen

Ankle fractures are among the most common injuries treated in orthopaedic practice. They involve fractures of the distal tibia, fibula, or both and may be associated with ligamentous injuries affecting ankle stability. Proper understanding of the mechanism of injury is essential for accurate diagnosis and appropriate treatment.

The Lauge-Hansen classification system describes ankle fractures based on the position of the foot at the time of injury and the direction of the deforming force. This classification provides insight into the sequential pattern of ligament and bone injuries that occur during ankle trauma.

Understanding these injury mechanisms helps clinicians predict associated ligament injuries, evaluate radiographs more accurately, and determine appropriate management strategies.

The ankle joint is a hinge joint formed by the articulation between the distal tibia, fibula, and talus. Stability of the ankle joint depends on both bony congruity and ligamentous structures.

• Distal tibia forms the medial malleolus
• Distal fibula forms the lateral malleolus
• Talus forms the ankle mortise articulation
• Syndesmotic ligaments stabilize tibia and fibula

The medial side of the ankle is supported by the strong deltoid ligament complex, while the lateral side contains the anterior talofibular, calcaneofibular, and posterior talofibular ligaments.

The ankle joint transmits body weight from the tibia to the foot during walking and running. Stability is maintained by the ankle mortise and surrounding ligamentous structures.

• Lateral malleolus prevents talar displacement
• Medial malleolus stabilizes medial ankle
• Syndesmosis maintains ankle mortise integrity
• Deltoid ligament resists eversion forces

Most ankle fractures occur due to twisting injuries of the ankle joint. The position of the foot and the direction of applied force determine the fracture pattern.

• Supination injuries
• Pronation injuries
• External rotation forces
• Adduction forces
• Abduction forces

The Lauge-Hansen classification is based on two components:

• Position of the foot (supination or pronation)
• Direction of deforming force

Supination-external rotation injuries are the most common ankle fracture pattern. The injury progresses through four stages.

• Stage 1 – Injury to anterior inferior tibiofibular ligament
• Stage 2 – Oblique fracture of distal fibula
• Stage 3 – Posterior malleolus fracture
• Stage 4 – Medial malleolus fracture or deltoid ligament rupture

• Pain around ankle
• Swelling and bruising
• Difficulty bearing weight
• Visible deformity in severe injuries
• Tenderness over malleoli

A careful examination is required to assess ligament injury and ankle stability.

• AP ankle radiograph
• Lateral ankle radiograph
• Mortise view radiograph
• CT scan for complex fractures

Radiographic evaluation helps determine fracture displacement, syndesmotic injury, and ankle mortise integrity.

• Restore anatomical alignment
• Maintain ankle mortise stability
• Achieve stable fixation
• Allow early ankle mobilization

• Ankle stiffness
• Post-traumatic arthritis
• Malunion
• Chronic ankle instability
• Infection

• Lauge-Hansen classification describes mechanism of injury
• Supination-external rotation is most common pattern
• Mortise view is essential for ankle evaluation
• Goal of treatment is restoration of ankle mortise