Skip to main content

Classification of Ankle Fractures

  • Chapter
  • First Online:
Evaluation and Surgical Management of the Ankle
  • 344 Accesses

Abstract

Ankle fracture classification systems categorize injuries based on common anatomic or biomechanical features for the purpose of facilitating diagnostic and treatment decisions and create a systematic nomenclature that facilitates the dissemination of research. The two most common ankle fracture classification systems are the Danis–Weber and the Lauge–Hansen systems. The Danis–Weber System is based on the level of the fibula fracture relative to the syndesmosis and has been incorporated into the AO/OTA (AO Foundation/Orthopaedic Trauma Association) classification, creating an exhaustive and detailed catalogue of ankle fractures. The Lauge–Hansen Classification system is based on mechanism of injury and provides valuable information regarding the underlying ligamentous injuries that effect the stability of the ankle mortise. Recently, relevant patterns of posterior malleolus injury have been recognized, leading to the development of the Mason and Malloy Classification of Posterior Malleolus Fractures. Each of these classification systems uniquely contribute to the understanding of these complex injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Boden SD, Labropoulos PA, McCowin P, Lestini WF, Hurwitz SR. Mechanical considerations for the syndesmosis screw. A cadaver study. J Bone Joint Surg Am. 1989;71(10):1548–55.

    Article  CAS  PubMed  Google Scholar 

  2. Michelson JD, Magid D, McHale K. Clinical utility of a stability-based ankle fracture classification system. J Orthop Trauma. 2007;21(5):307–15.

    Article  PubMed  Google Scholar 

  3. Pakarinen H. Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury. Acta Orthop Suppl. 2012;83(347):1–26.

    Article  PubMed  Google Scholar 

  4. Pakarinen HJ, Flinkkil TE, Ohtonen PP, Ristiniemi JY. Stability criteria for nonoperative ankle fracture management. Foot Ankle Int. 2011;32(2):141–7.

    Article  PubMed  Google Scholar 

  5. Fox A, Wykes P, Eccles K, Barrie J. Five years of ankle fractures grouped by stability. Injury. 2005;36(7):836–41.

    Article  PubMed  Google Scholar 

  6. Michelson J, Solocoff D, Waldman B, Kendell K, Ahn U, Ankle fractures. The Lauge-Hansen classification revisited. Clin Orthop Relat Res. 1997;345:198–205.

    Google Scholar 

  7. Delaney JP, Charlson MD, Michelson JD. Ankle fracture stability-based classification: a study of reproducibility and clinical prognostic ability. J Orthop Trauma. 2019;33(9):465–71.

    Article  PubMed  Google Scholar 

  8. Müller ME, Perren SM, Allgöwer M, Müller ME, Schneider R, Willenegger H. Manual of internal fixation: techniques recommended by the AO-ASIF group. Berlin: Springer Science & Business Media; 1991.

    Book  Google Scholar 

  9. Muller MAM, Schneider R, Willenegger H. Manual of internal fixation. Techniques recommended by the AO Group. New York: Springer; 1979.

    Book  Google Scholar 

  10. Lindsjo U. Classification of ankle fractures: the Lauge-Hansen or AO system? Clin Orthop Relat Res. 1985;199:12–6.

    Article  Google Scholar 

  11. Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures—an increasing problem? Acta Orthop Scand. 1998;69(1):43–7.

    Article  CAS  PubMed  Google Scholar 

  12. Rydberg EM, Zorko T, Sundfeldt M, Moller M, Wennergren D. Classification and treatment of lateral malleolar fractures—a single-center analysis of 439 ankle fractures using the Swedish fracture register. BMC Musculoskelet Disord. 2020;21(1):521.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle. 1990;10(6):325–30.

    Article  CAS  PubMed  Google Scholar 

  14. El-Rosasy M, Ali T. Realignment-lengthening osteotomy for malunited distal fibular fracture. Int Orthop. 2013;37(7):1285–90.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hinds RM, Schottel PC, Berkes MB, Little MT, Helfet DL, Lorich DG. Evaluation of Lauge-Hansen designation of Weber C fractures. J Foot Ankle Surg. 2014;53(4):434–9.

    Article  PubMed  Google Scholar 

  16. Broos PL, Bisschop AP. Operative treatment of ankle fractures in adults: correlation between types of fracture and final results. Injury. 1991;22(5):403–6.

    Article  CAS  PubMed  Google Scholar 

  17. Pettrone FA, Gail M, Pee D, Fitzpatrick T, Van Herpe LB. Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am. 1983;65(5):667–77.

    Article  CAS  PubMed  Google Scholar 

  18. Michelson JD, Magid D, Ney DR, Fishman EK. Examination of the pathologic anatomy of ankle fractures. J Trauma. 1992;32(1):65–70.

    Article  CAS  PubMed  Google Scholar 

  19. Bhimani R, Ashkani-Esfahani S, Lubberts B, Kaiser P, Kerkhoffs G, Waryasz G, et al. Utility of WBCT to diagnose syndesmotic instability in patients with Weber B lateral malleolar fractures. J Am Acad Orthop Surg. 2021;30:e423.

    Article  Google Scholar 

  20. Ramos LS, Goncalves HM, Freitas A, Oliveira MP, Lima DMS, Carmargo WS. Evaluation of the reproducibility of Lauge-Hansen, Danis-Weber, and AO classifications for ankle fractures. Rev Bras Ortop (Sao Paulo). 2021;56(3):372–8.

    PubMed  Google Scholar 

  21. Harper MC. Ankle fracture classification systems: a case for integration of the Lauge-Hansen and AO-Danis-Weber schemes. Foot Ankle. 1992;13(7):404–7.

    Article  CAS  PubMed  Google Scholar 

  22. Alexandropoulos C, Tsourvakas S, Papachristos J, Tselios A, Soukouli P. Ankle fracture classification: an evaluation of three classification systems: Lauge-Hansen, A.O. and Broos-Bisschop. Acta Orthop Belg. 2010;76(4):521–5.

    PubMed  Google Scholar 

  23. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32(Suppl 1):S1–S170.

    Article  PubMed  Google Scholar 

  24. Malleolar segment. J Orthop Trauma. 2018;32:S65–S70.

    Google Scholar 

  25. Kennedy JG, Johnson SM, Collins AL, DalloVedova P, McManus WF, Hynes DM, et al. An evaluation of the weber classification of ankle fractures. Injury. 1998;29(8):577–80.

    Article  CAS  PubMed  Google Scholar 

  26. Sung KH, Kwon SS, Yun YH, Park MS, Lee KM, Nam M, et al. Short-term outcomes and influencing factors after ankle fracture surgery. J Foot Ankle Surg. 2018;57(6):1096–100.

    Article  PubMed  Google Scholar 

  27. Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950;60(5):957–85.

    Article  CAS  Google Scholar 

  28. Chun DI, Kim J, Kim YS, Cho JH, Won SH, Park SY, et al. Relationship between fracture morphology of lateral malleolus and syndesmotic stability after supination-external rotation type ankle fractures. Injury. 2019;50(7):1382–7.

    Article  PubMed  Google Scholar 

  29. Pankovich AM. Maisonneuve fracture of the fibula. J Bone Joint Surg Am. 1976;58(3):337–42.

    Article  CAS  PubMed  Google Scholar 

  30. Kortekangas TH, Pakarinen HJ, Savola O, Niinimaki J, Lepojarvi S, Ohtonen P, et al. Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study. Foot Ankle Int. 2014;35(10):988–95.

    Article  PubMed  Google Scholar 

  31. Jeong BO, Kim TY, Baek JH, Song SH, Park JS. Assessment of ankle mortise instability after isolated supination-external rotation lateral malleolar fractures. J Bone Joint Surg Am. 2018;100(18):1557–62.

    Article  PubMed  Google Scholar 

  32. Kahan J, Brand J, Schneble C, Li D, Saad M, Kuether J, et al. Open pronation abduction ankle fractures associated with increased complications and patient BMI. Injury. 2020;51(4):1109–13.

    Article  PubMed  Google Scholar 

  33. Hinds RM, Tran WH, Lorich DG. Maisonneuve-hyperplantarflexion variant ankle fracture. Orthopedics. 2014;37(11):e1040–4.

    Article  PubMed  Google Scholar 

  34. Haraguchi N, Armiger RS. A new interpretation of the mechanism of ankle fracture. J Bone Joint Surg Am. 2009;91(4):821–9.

    Article  PubMed  Google Scholar 

  35. Shariff SS, Nathwani DK. Lauge-Hansen classification—a literature review. Injury. 2006;37(9):888–90.

    Article  PubMed  Google Scholar 

  36. Rodriguez EK, Kwon JY, Herder LM, Appleton PT. Correlation of AO and Lauge-Hansen classification systems for ankle fractures to the mechanism of injury. Foot Ankle Int. 2013;34(11):1516–20.

    Article  PubMed  Google Scholar 

  37. Kwon JY, Chacko AT, Kadzielski JJ, Appleton PT, Rodriguez EK. A novel methodology for the study of injury mechanism: ankle fracture analysis using injury videos posted on YouTube.com. J Orthop Trauma. 2010;24(8):477–82.

    Article  PubMed  Google Scholar 

  38. Mason LW, Marlow WJ, Widnall J, Molloy AP. Pathoanatomy and associated injuries of posterior malleolus fracture of the ankle. Foot Ankle Int. 2017;38(11):1229–35.

    Article  PubMed  Google Scholar 

  39. Warner SJ, Garner MR, Hinds RM, Helfet DL, Lorich DG. Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures. J Orthop Trauma. 2015;29(12):574–8.

    Article  PubMed  Google Scholar 

  40. Nielsen JO, Dons-Jensen H, Sorensen HT. Lauge-Hansen classification of malleolar fractures. An assessment of the reproducibility in 118 cases. Acta Orthop Scand. 1990;61(5):385–7.

    Article  CAS  PubMed  Google Scholar 

  41. Jehlicka D, Bartonícek J, Svatos F, Dobiás J. Fracture-dislocations of the ankle joint in adults. Part I: epidemiologic evaluation of patients during a 1-year period. Acta Chir Orthop Traumatol Cech. 2002;69(4):243–7.

    CAS  PubMed  Google Scholar 

  42. de Souza LJ, Gustilo RB, Meyer TJ. Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg Am. 1985;67(7):1066–74.

    Article  PubMed  Google Scholar 

  43. Hartford JM, Gorczyca JT, McNamara JL, Mayor MB. Tibiotalar contact area. Contribution of posterior malleolus and deltoid ligament. Clin Orthop Relat Res. 1995;320:182–7.

    Google Scholar 

  44. Macko VW, Matthews LS, Zwirkoski P, Goldstein SA. The joint-contact area of the ankle. The contribution of the posterior malleolus. J Bone Joint Surg Am. 1991;73(3):347–51.

    Article  CAS  PubMed  Google Scholar 

  45. McDaniel WJ, Wilson FC. Trimalleolar fractures of the ankle. An end result study. Clin Orthop Relat Res. 1977;122:37–45.

    Google Scholar 

  46. Gardner MJ, Brodsky A, Briggs SM, Nielson JH, Lorich DG. Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res. 2006;447:165–71.

    Article  PubMed  Google Scholar 

  47. Miller MA, McDonald TC, Graves ML, Spitler CA, Russell GV, Jones LC, et al. Stability of the syndesmosis after posterior malleolar fracture fixation. Foot Ankle Int. 2018;39(1):99–104.

    Article  PubMed  Google Scholar 

  48. Drijfhout van Hooff CC, Verhage SM, Hoogendoorn JM. Influence of fragment size and postoperative joint congruency on long-term outcome of posterior malleolar fractures. Foot Ankle Int. 2015;36(6):673–8.

    Article  PubMed  Google Scholar 

  49. Bartonicek J, Rammelt S, Kostlivy K, Vanecek V, Klika D, Tresl I. Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg. 2015;135(4):505–16.

    Article  PubMed  Google Scholar 

  50. Langenhuijsen JF, Heetveld MJ, Ultee JM, Steller EP, Butzelaar RM. Results of ankle fractures with involvement of the posterior tibial margin. J Trauma. 2002;53(1):55–60.

    Article  PubMed  Google Scholar 

  51. Gonzalez O, Fleming JJ, Meyr AJ. Radiographic assessment of posterior malleolar ankle fractures. J Foot Ankle Surg. 2015;54(3):365–9.

    Article  PubMed  Google Scholar 

  52. Vosoughi AR, Jayatilaka MLT, Fischer B, Molloy AP, Mason LW. CT analysis of the posteromedial fragment of the posterior malleolar fracture. Foot Ankle Int. 2019;40(6):648–55.

    Article  PubMed  Google Scholar 

  53. Yi Y, Chun DI, Won SH, Park S, Lee S, Cho J. Morphological characteristics of the posterior malleolar fragment according to ankle fracture patterns: a computed tomography-based study. BMC Musculoskelet Disord. 2018;19(1):51.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Bartoníček J, Rammelt S, Tuček M. Posterior malleolar fractures: changing concepts and recent developments. Foot Ankle Clin. 2017;22(1):125–45.

    Article  PubMed  Google Scholar 

  55. Mason LW, Kaye A, Widnall J, Redfern J, Molloy A. Posterior malleolar Ankle fractures: an effort at improving outcomes. JB JS Open Access. 2019;4(2):e0058.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ross Taylor .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Taylor, R. (2023). Classification of Ankle Fractures. In: Herscovici Jr., D., Anglen, J.O., Early, J.S. (eds) Evaluation and Surgical Management of the Ankle. Springer, Cham. https://doi.org/10.1007/978-3-031-33537-2_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-33537-2_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-33536-5

  • Online ISBN: 978-3-031-33537-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics