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Correlation Between the Lauge-Hansen Classification and Ligament Injuries in Ankle Fractures

Warner, Stephen J. MD, PhD*; Garner, Matthew R. MD*; Hinds, Richard M. MD*; Helfet, David L. MD; Lorich, Dean G. MD

doi: 10.1097/BOT.0000000000000393
Original Article
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Objective: To evaluate the ability of the Lauge-Hansen classification to predict ligament injuries in ankle fractures using magnetic resonance imaging (MRI) and intraoperative findings.

Design: Prospective evaluation in consecutive patients.

Setting: Academic level 1 trauma center.

Patients: Three-hundred patients with an operatively treated ankle fracture who met the inclusion and exclusion criteria.

Intervention: 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.

Main Outcome Measurements: Comparisons were made between the predicted ankle ligamentous injuries based on radiographic Lauge-Hansen classifications, preoperative MRI analyses, and intraoperative findings.

Results: 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.

Conclusions: 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.

Level of Evidence: 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: warners@hss.edu).

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

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