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Classifications in Brief: Lauge-Hansen Classification of Ankle Fractures

2015; Lippincott Williams & Wilkins; Volume: 473; Issue: 10 Linguagem: Inglês

10.1007/s11999-015-4306-x

1528-1132

Jason P. Tartaglione, Andrew J. Rosenbaum, Mostafa M. Abousayed, John A. DiPreta,

Orthopedic Surgery and Rehabilitation

HistoryAnkle fractures are common musculoskeletal injuries thatoccur in a bimodal distribution, with peaks in younger menand older women [2], the former related to high-energytrauma and the latter to osteopenia and osteoporosis.Although ankle fractures currently account for 9% offractures, incidence and severity are increasing [1]. This isattributed to the increased life expectancy among olderindividuals and improved survival of patients with severefoot and ankle trauma [23, 26].The first ankle fracture classification, credited to Perci-val Pott, described three types of ankle fractures based onthe number of malleoli involved: unimalleolar, bimalleolar,and trimalleolar [21]. Despite its ease of use and repro-ducibility, the classification did not effectively guidemanagement, as it failed to differentiate stable from un-stable injuries.This was the impetus for the work of Niel Lauge-Hansen(1899–1976), a Danish physician who studied ankle frac-tures during the 1940s and 1950s, ultimately creating aclassification system based on a rotational mechanism ofinjury [11–15]. Lauge-Hansen’s classification, which waspublished in a 1950 issue of Archives of Surgery, has be-come one of the most widely used ankle fractureclassification systems [12]. Although still considered alandmark work regarding the biomechanics and deformingforces of ankle fractures, the quality, validity, and repro-ducibility of the Lauge-Hansen classification have beenchallenged [17, 19, 22, 25].PurposeAn ideal fracture classification would be reproducible,widely recognized, relevant for prognosis, and useful interms of clinical decision-making, documentation, andresearch.The primary normal motion of the ankle is dorsiflexionand plantar flexion, with osseous anatomy and ligamentouscomplexes that provide stability in all planes and axes ofrotation. When these structures are injured, there is sub-stantial risk of instability. Appropriate reconstructiontherefore is important, and a classification scheme thatidentifies injury patterns and guides treatment would bedesirable.Description of the Lauge-Hansen SystemNiel Lauge-Hansen used freshly amputated limbs to de-velop an ankle fracture classification based on foot positionat the time of the traumatic event (supination or pronation)and the direction of the deforming forces (abduction, ad-duction, or external rotation) [12].Cadaveric tibias were fixed with a vice and nails while arotational deforming force was applied by hand with the