Authors: Jason P Tartaglione Andrew J Rosenbaum Mostafa Abousayed John A DiPreta
Publish Date: 2015/04/22
Volume: 473, Issue: 10, Pages: 3323-3328
Abstract
Ankle fractures are common musculoskeletal injuries that occur in a bimodal distribution with peaks in younger men and older women 2 the former related to highenergy trauma and the latter to osteopenia and osteoporosis Although ankle fractures currently account for 9 of fractures incidence and severity are increasing 1 This is attributed to the increased life expectancy among older individuals and improved survival of patients with severe foot and ankle trauma 23 26The first ankle fracture classification credited to Percival Pott described three types of ankle fractures based on the number of malleoli involved unimalleolar bimalleolar and trimalleolar 21 Despite its ease of use and reproducibility the classification did not effectively guide management as it failed to differentiate stable from unstable injuriesThis was the impetus for the work of Niel LaugeHansen 1899–1976 a Danish physician who studied ankle fractures during the 1940s and 1950s ultimately creating a classification system based on a rotational mechanism of injury 11 12 13 14 15 LaugeHansen’s classification which was published in a 1950 issue of Archives of Surgery has become one of the most widely used ankle fracture classification systems 12 Although still considered a landmark work regarding the biomechanics and deforming forces of ankle fractures the quality validity and reproducibility of the LaugeHansen classification have been challenged 17 19 22 25The primary normal motion of the ankle is dorsiflexion and plantar flexion with osseous anatomy and ligamentous complexes that provide stability in all planes and axes of rotation When these structures are injured there is substantial risk of instability Appropriate reconstruction therefore is important and a classification scheme that identifies injury patterns and guides treatment would be desirableNiel LaugeHansen used freshly amputated limbs to develop an ankle fracture classification based on foot position at the time of the traumatic event supination or pronation and the direction of the deforming forces abduction adduction or external rotation 12
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