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Ankle fractures
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Oliver Chan, Anthony Sakellariou
The Lauge-Hansen classification system allows a better understanding of the mechanism of injury and can be used to predict hidden injuries which may not be easily appreciable on initial non–weight-bearing radiographs of the ankle. More importantly, this system can aid management as stability can be inferred based on the classification grading. More recently the SER Type 4 injury (Lauge-Hansen classification) has been modified to 4a (PTTL portion of the deltoid ligament intact, thereby conferring stability whilst bearing weight, despite talar shift on NWB radiographs) and 4b (PTTL portion ruptured, no stability, with talar shift on both NWB and WB radiographs) (7).
Foot and ankle
Published in Pankaj Sharma, Nicola Maffulli, Practice Questions in Trauma and Orthopaedics for the FRCS, 2017
Pankaj Sharma, Nicola Maffulli
A Weber C fracture is a fracture of the distal fibula above the level of the ankle syndesmosis. The Lauge-Hansen classification is based on the mechanism of injury. Pronation and external rotation will result in a fracture of the distal fibula above the level of the syndesmosis.
Ankle fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Murray D. Spruiell, Cyril Mauffrey
The Lauge-Hansen classification7 is based on the position of the foot at the time of fracture (supination or pronation) and the direction of the deforming force (abduction, adduction, internal or external rotation). This gives four types of injury, these being supination external rotation (SER), pro-nation external rotation (PER), supination adduction (SA) and pronation abduction (PA). A number is then applied which refers to the progression through the stages of bone and soft tissue injury. The Lauge–Hansen classification is summarized in Table 42.1. The AO/OTA8 classification is derived from the earlier Weber classification and is a morphological classification. Type A fractures occur below the level of the inferior tibio-fibular syndesmotic ligaments. A1 fractures are unifocal lateral lesions. In A2 fractures there is an associated medial malleolar fracture and in A3 fractures there is an associated posteromedial fracture. Type B fractures are trans-syndesmotic fractures. In B1 fractures there is an oblique or spiral distal fibular fracture. In B2 fractures there is an associated medial malleolar fracture and in B3 fractures there is an associated posterior malleolar fracture. Type C fractures are rare in the elderly. These are supra-syndesmotic fractures with C1 fractures having a simple fibular fracture with damage to the anterior tibio-fibular ligaments. In C2 fractures the fibular fracture is multifragmentary and in C3 fractures the fibular fracture is located in the proximal fibula.
What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?
Published in Acta Orthopaedica, 2018
Hoon Park, Dong Hoon Lee, Seung Hwan Han, Sungmin Kim, Nam Kyu Eom, Hyun Woo Kim
Data included patient age at the time of injury, sex, mechanism of injury, presence of concurrent fibular fracture, amount of initial displacement before reduction, amount of residual displacement after reduction, the type of implant used, and occurrence of PPC. Initial displacement before reduction was measured from radiographs as the greatest amount of displacement (in millimeters) between the epiphysis and the metaphysis (Figure 1). Residual displacement after reduction was measured on coronal or sagittal CT images using the same method. Initial displacement was measured in 65/70 patients in Group 2. However, in Group 1, initial displacement was measured in only 6/25 patients. Some patients in Group 1 did not bring their initial radiographs before closed reduction, others brought only CT images, the remainder had inappropriate radiographs to measure the gaps. The mechanism of injury was classified as SER, ABD, or PER based on the Lauge-Hansen classification system (Lauge-Hansen 1950) (Figure 2). The physis was evaluated from bilateral anteroposterior or lateral radiographs during all follow-up appointments. If PPC was questionable, a CT scan was obtained to investigate the presence of a physeal bar. All radiological measurements were performed by 2 orthopedic surgeons (SK and NKE) who were blinded to the study.