According to Lauge-Hansen the fracture results from an exorotation force on the supinated foot. Stage 1 is usually not visible on x-rays. What we normally see is a stage 2 oblique fracture through the syndesmosis and we have to assume that there is also a rupture of the anterior tibiofibular ligament, which is stage 1. According to Lauge Hansen the first injury is on the lateral side, which is under maximum tension. In stage 2 the talus exorotates further and since the foot is in supination, the lateral malleolus is held tightly in place by the lateral collateral ligaments. The lateral malleolus cannot move away without breaking.
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With more force, the posterior inferior tibiofibular ligament PITFL was injured or the posterior malleolus was fractured in Stage 3.
Finally, in Stage 4, the medial malleolus was fractured or the deltoid ligament was injured [ 12 ]. Supination adduction injuries occurred in eight experiments and consisted of two stages. In Stage 1, either a transverse fracture of the lateral malleolus below the level of the tibial plafond was produced or the lateral ligaments of the ankle were avulsed off of the distal fibula.
In Stage 2, either a vertical medial malleolus fracture or injury to the deltoid ligament occurred [ 12 ]. Pronation external rotation injuries were recreated in four experiments, with either deltoid ligament rupture or avulsion fractures of the medial malleolus evident in Stage 1. Pronation abduction injuries were evaluated in three experiments. Stage 1 injuries involved fractures of the medial malleolus, whereas Stage 2 injuries were associated with damage to the AITFL.
In Stage 3, transverse or comminuted fibula fractures were observed above the level of the tibial plafond [ 12 ]. In an attempt to create a classification system that did not rely on the mechanism of injury, which rarely is truly known and often speculated, Danis and Weber created an ankle fracture classification based on radiographic criteria.
This classification system took into consideration the position of the distal fibular fracture in relation to the syndesmosis [ 4 , 27 ].
According to the Danis-Weber classification, a Type A fracture occurs below the level of the tibial plafond and may be associated with oblique or vertical medial malleolar fractures [ 4 , 27 ], which correlates with the supination adduction pattern described by Lauge-Hansen Fig.
Danis-Weber Type C fractures occur proximal to the level of the tibial plafond and often have an associated syndesmotic injury [ 4 , 12 , 27 ], which correlates with pronation external rotation Fig. Danis-Weber Type C fractures can be associated with medial malleolus fractures or injury to the deltoid ligament.
Ankle fracture - Weber and Lauge-Hansen Classification