Lauge-Hansen used fresh amputated lower extremities to systematically reproduce every major ankle fracture type by controlling foot position and force direction. The study defines four fracture types — Supination-Adduction, Supination-Eversion, Pronation-Abduction, and Pronation-Eversion — each with sequential injury stages. The central question: what is the exact order of ligamentous and bony failure for each mechanism, and what does that sequence look like on radiograph?
The fibular fracture level on the mortise radiograph is a direct readout of injury mechanism and syndesmotic status.
When you see a transverse fibular fracture at or below the plafond — think SA or SER Stage 2. The syndesmosis is intact. When you see a fibular fracture above the plafond, location determines urgency: 0.5–1 cm above means PA (bending fracture, syndesmosis disrupted but low); ≥8–9 cm above means PER, and the entire syndesmosis from AITFL to interosseous membrane is gone.
For any PER-pattern injury, a mortise view alone is insufficient. The fibula must be imaged to its full length. A mid-shaft or proximal fibular fracture with an ankle injury is a Maisonneuve pattern. And the talus is one step away from central luxation if reduction is not obtained.
This paper is the foundation for why we treat syndesmotic injuries differently from isolated malleolar fractures. The Lauge-Hansen stage tells you which structures failed, and that list is exactly what must be reduced and stabilized to restore the mortise.
Lauge-Hansen used fresh amputated lower extremities to systematically reproduce every major ankle fracture type by controlling foot position and force direction. The study defines four fracture types — Supination-Adduction, Supination-Eversion, Pronation-Abduction, and Pronation-Eversion — each with sequential injury stages. The central question: what is the exact order of ligamentous and bony failure for each mechanism, and what does that sequence look like on radiograph?
The fibular fracture level on the mortise radiograph is a direct readout of injury mechanism and syndesmotic status.
When you see a transverse fibular fracture at or below the plafond — think SA or SER Stage 2. The syndesmosis is intact. When you see a fibular fracture above the plafond, location determines urgency: 0.5–1 cm above means PA (bending fracture, syndesmosis disrupted but low); ≥8–9 cm above means PER, and the entire syndesmosis from AITFL to interosseous membrane is gone.
For any PER-pattern injury, a mortise view alone is insufficient. The fibula must be imaged to its full length. A mid-shaft or proximal fibular fracture with an ankle injury is a Maisonneuve pattern. And the talus is one step away from central luxation if reduction is not obtained.
This paper is the foundation for why we treat syndesmotic injuries differently from isolated malleolar fractures. The Lauge-Hansen stage tells you which structures failed, and that list is exactly what must be reduced and stabilized to restore the mortise.