This 2015 'Classifications in Brief' review covers the Lauge-Hansen ankle fracture classification from its 1950 cadaveric origins through modern validation studies. It describes all four injury patterns (SER, SA, PER, PA) with their sequential stages, maps each onto the Danis-Weber and AO/OTA systems, and critically appraises the evidence for and against its reliability and clinical utility.
When you see an ankle fracture, Lauge-Hansen gives you a conceptual scaffold — but do not trust it to tell you what the ligaments are doing. Gardner et al. Showed that the system gets the soft tissue injury wrong 53% of the time on MRI. This is why clinical instability assessment and stress radiographs (or MRI) matter more than pattern recognition alone for operative decision-making.
The AO/OTA 44 system is more comprehensive and more reliable: it captures medial and posterior malleolar injuries that Danis-Weber ignores, classifies fractures that Lauge-Hansen cannot (e.g., isolated posterior tibial margin fractures), and predicts injury pattern from mechanism better (81% vs 65%).
Know Lauge-Hansen cold for boards and for understanding why a fibular fracture above the plafond signals syndesmotic risk. Apply AO/OTA in practice. The two systems are complementary, not competing.
This 2015 'Classifications in Brief' review covers the Lauge-Hansen ankle fracture classification from its 1950 cadaveric origins through modern validation studies. It describes all four injury patterns (SER, SA, PER, PA) with their sequential stages, maps each onto the Danis-Weber and AO/OTA systems, and critically appraises the evidence for and against its reliability and clinical utility.
When you see an ankle fracture, Lauge-Hansen gives you a conceptual scaffold — but do not trust it to tell you what the ligaments are doing. Gardner et al. Showed that the system gets the soft tissue injury wrong 53% of the time on MRI. This is why clinical instability assessment and stress radiographs (or MRI) matter more than pattern recognition alone for operative decision-making.
The AO/OTA 44 system is more comprehensive and more reliable: it captures medial and posterior malleolar injuries that Danis-Weber ignores, classifies fractures that Lauge-Hansen cannot (e.g., isolated posterior tibial margin fractures), and predicts injury pattern from mechanism better (81% vs 65%).
Know Lauge-Hansen cold for boards and for understanding why a fibular fracture above the plafond signals syndesmotic risk. Apply AO/OTA in practice. The two systems are complementary, not competing.