Ankle fractures. The Lauge-Hansen classification revisited

Rational treatment of ankle fractures requires knowledge of the extent of bone and soft tissue injury. Although the Lauge-Hansen classification attempts to do this by relating specific fracture patterns to injury mechanism, the experimental underpinning for this classification has not been reexamined rigorously using modern experimental methods. This study examines the hypothesis that the clinically occurring supination and external rotation injury pattern does not result from the mechanism described by Lauge-Hansen. Thirty-two anatomic specimen ankles were mounted on an MTS machine for combined axial loading with external rotation to failure testing. A foot plate supinated the foot 25 degrees. Testing was performed with the ankle at neutral, 25 degrees plantar flexed, 10 degrees to 15 degrees dorsiflexed, and in 6 degrees to 8 degrees leg valgus. Pure supination and external rotation with the ankle in neutral did not result in the Lauge-Hansen supination and external rotation type fractures. This outcome was not altered if the ankle specimens initially were placed in plantar flexion or dorsiflexion. The addition of a valgus load, which pushes the talus laterally against the fibula, resulted in the classic Lauge-Hansen supination and external rotation type fracture. All specimens had an isolated lateral injury or a lateral injury that preceded medial injury.