Ankle Fractures – Classification

---

Overview

• Classification of ankle fractures helps determine:
  • Mechanism of injury
  • Stability
  • Treatment strategy

---

Two Most Common Systems

• Weber Classification – Based on fracture level
• Lauge-Hansen Classification – Based on mechanism

---

1. Weber Classification

---

Principle

• Based on level of fibular fracture relative to:
  • Syndesmosis (distal tibiofibular joint)

---

Weber Type A

---

• Fracture below syndesmosis

---

Features

• Usually stable
• Syndesmotic injury uncommon
• Often associated with:
  • Supination–adduction injuries

---

Associated Injuries

• Medial malleolus fracture may be present

---

Weber Type B

---

• Fracture at level of syndesmosis

---

Features

• Most common type
• Stability varies

---

Associations

• May or may not involve syndesmosis
• Often:
  • Supination–external rotation injuries

---

Weber Type C

---

• Fracture above syndesmosis

---

Features

• Usually unstable
• High likelihood of:
  • Syndesmotic disruption
  • Deltoid ligament injury

---

Management Note

• Often requires:
  • Syndesmotic screw fixation

---

2. Lauge-Hansen Classification

---

Principle

• Based on mechanism of injury

---

Components

1. Foot Position

• Supination
• Pronation

---

2. Direction of Force

• Adduction
• Abduction
• External rotation

---

Result

• Combination – 4 injury patterns

---

Types of Lauge-Hansen Injuries

---

1. Supination–Adduction (SA)

---

Characteristics

• Vertical medial malleolus fracture
• Transverse distal fibular fracture
• Medial talar displacement
• Anteromedial plafond impaction

---

Surgical Considerations

• Fixation:
  • Parallel lag screws
  • Anti-glide plate

---

Additional Steps

• Elevate impacted plafond
• Restore articular surface

---

Clinical Note

• Often fix medial side first

---

2. Supination–External Rotation (SER)

---

Key Fact

• Most common mechanism

---

Fibular Fracture Pattern

• Oblique:
  • Anterior-inferior – posterior-superior

---

Stages

1. AITFL injury
2. Oblique fibular fracture
3. Posterior malleolus fracture
4. Medial malleolus fracture / deltoid injury

---

Important Clinical Point

• Always rule out Stage 4 injury

---

Investigation

• Stress radiographs:
  • Detect medial instability

---

Treatment

• Stage 2 – Conservative
• Stage 4 – Surgical fixation

---

3. Pronation–External Rotation (PER)

---

Characteristics

• Injury starts medially

---

Sequence

1. Medial injury
2. Syndesmotic injury
3. High fibular fracture
4. Posterior malleolus involvement

---

Fibular Fracture

• Above joint level
• Often Weber C equivalent

---

4. Pronation–Abduction (PA)

---

Sequence

1. Medial malleolus fracture / deltoid injury
2. Syndesmotic injury
3. Fibular fracture

---

Fibular Pattern

• Transverse or comminuted

---

Clinical Note

• May show:
  • Syndesmotic injury without fibular fracture

---

Key Exam Points

---

• Weber classification – Level of fibular fracture
• Lauge-Hansen classification – Mechanism

---

High-Yield Facts

• Weber B – Most common fracture type
• SER- Most common mechanism
• SER Stage 4 – Requires surgery
• Weber C – Often needs syndesmotic fixation

Courtesy: Saqib Rehman MD
Associate Professor
Director of Orthopaedic Trauma
Temple Univesity
Philadelphia, Pennsylvania, USA
www.orthoclips.com