To evaluate the ability of the Lauge-Hansen classification to predict ligament injuries in ankle fractures using magnetic resonance imaging (MRI) and intraoperative findings.
Prospective evaluation in consecutive patients.
Academic level 1 trauma center.
Three-hundred patients with an operatively treated ankle fracture who met the inclusion and exclusion criteria.
Injury ankle radiographs were assigned to a Lauge-Hansen classification. MRI scans were obtained to evaluate the syndesmotic and deltoid ligaments. A Lauge-Hansen classification for each patient was recorded based on intraoperative findings.
Comparisons were made between the predicted ankle ligamentous injuries based on radiographic Lauge-Hansen classifications, preoperative MRI analyses, and intraoperative findings.
On the basis of the Lauge-Hansen system and injury radiographs, 77% (231/300) were classified as supination external rotation, 13% (40/300) were pronation external rotation, 4% (11/300) were supination adduction, <1% (1/300) was pronation abduction, and 6% (17/300) were not classifiable. Of the 283 fractures that were classified into Lauge-Hansen classes, 266 (94%) had MRI readings of ligamentous injuries consistent with the Lauge-Hansen predictions. Intraoperative findings also highly correlated with the Lauge-Hansen class of ankle fractures, with nearly complete agreement. Comparing MRI and intraoperative findings revealed discrepancies in 6% (16/283) of ankle fracture classifications.
In our large cohort of patients, comparisons between injury radiographs, preoperative MRI, and intraoperative findings suggest that the Lauge-Hansen system is an accurate predictor of ligamentous injuries. The predictions based on the Lauge-Hansen system can be useful for fracture reduction maneuvers and operative planning.
Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
*Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY; and
†Orthopaedic Trauma Service, Hospital for Special Surgery and Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY.
Reprints: Stephen J. Warner, MD, PhD, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 (e-mail: firstname.lastname@example.org).
Presented in part at the Annual Meeting of the Orthopaedic Trauma Association, October 16, 2014, Tampa, FL.
The authors report no conflict of interest.
Accepted July 09, 2015