The Ability of the Lauge-Hansen Classification to Predict Ligament Injury and Mechanism in Ankle Fractures: An MRI Study
OBJECTIVESThe Lauge-Hansen classification system was designed to predict the mechanism and ligament injury patterns of ankle fractures on the basis of x-rays. The purpose of this study was to evaluate the accuracy of these predicted injury sequences using magnetic resonance imaging (MRI) in a series...
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| creator | Gardner, Michael J Demetrakopoulos, Demetris Briggs, Stephen M Helfet, David L Lorich, Dean G |
| description | OBJECTIVESThe Lauge-Hansen classification system was designed to predict the mechanism and ligament injury patterns of ankle fractures on the basis of x-rays. The purpose of this study was to evaluate the accuracy of these predicted injury sequences using magnetic resonance imaging (MRI) in a series of patients with ankle fractures.
DESIGNRetrospective cohort.
SETTINGTwo university level 1 trauma centers.
PATIENTSFifty-nine patients with operative ankle fractures who were evaluated with both x-ray and MRI were included.
INTERVENTIONAll patients had a standard 3-view ankle x-ray series before fracture reduction, followed by an MRI. All plain x-rays were assigned to a Lauge-Hansen category by an experienced orthopedic traumatologist. MRI studies were subsequently read by an MRI musculoskeletal radiologist for the integrity of the ankle ligaments.
MAIN OUTCOME MEASUREMENTSAfter evaluation of the x-rays, fractures were classified according to the system of Lauge-Hansen, and the predicted presence, sequence, and mechanism of injury was determined. These were then compared to the actual injured structures on MRI in each case, and the ability of the Lauge-Hansen system to accurately predict the complete injury pattern was determined for the entire cohort.
RESULTSAverage patient age was 59 (range18 to 84) years. Of the 59 ankle fractures evaluated, 37 (63%) were classified as supination external rotation, 11 (19%) were pronation external rotation, 1 (2%) was supination adduction, and 10 (17%) were not classifiable on the basis of the Lauge-Hansen system. Of the 49 fractures that fit into Lauge-Hansen categories, 26 (53%) had patterns of ligamentous injury and fracture morphology that did not coincide with the Lauge-Hansen predictions. A common fracture pattern was observed in 8 of the 10 unclassifiable fractures, which included a high spiral fracture of the fibula, vertical shear fracture of the medial malleolus, posterior malleolar fracture, and complete tears of the anterior–inferior tibiofibular ligament and the interosseous membrane. In addition, over 65% of patients in this series had complete ligamentous injury and a fracture of the malleolus to which the ligament attaches.
CONCLUSIONSThese results demonstrate that the Lauge-Hansen classification system may have some limitations as a predictor of the mechanism of injury and the presence of soft-tissue damage associated with ankle fractures. The identification of a novel pattern of ankle fracture also illustr |
| doi_str_mv | 10.1097/00005131-200604000-00006 |
| format | Article |
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DESIGNRetrospective cohort.
SETTINGTwo university level 1 trauma centers.
PATIENTSFifty-nine patients with operative ankle fractures who were evaluated with both x-ray and MRI were included.
INTERVENTIONAll patients had a standard 3-view ankle x-ray series before fracture reduction, followed by an MRI. All plain x-rays were assigned to a Lauge-Hansen category by an experienced orthopedic traumatologist. MRI studies were subsequently read by an MRI musculoskeletal radiologist for the integrity of the ankle ligaments.
MAIN OUTCOME MEASUREMENTSAfter evaluation of the x-rays, fractures were classified according to the system of Lauge-Hansen, and the predicted presence, sequence, and mechanism of injury was determined. These were then compared to the actual injured structures on MRI in each case, and the ability of the Lauge-Hansen system to accurately predict the complete injury pattern was determined for the entire cohort.
RESULTSAverage patient age was 59 (range18 to 84) years. Of the 59 ankle fractures evaluated, 37 (63%) were classified as supination external rotation, 11 (19%) were pronation external rotation, 1 (2%) was supination adduction, and 10 (17%) were not classifiable on the basis of the Lauge-Hansen system. Of the 49 fractures that fit into Lauge-Hansen categories, 26 (53%) had patterns of ligamentous injury and fracture morphology that did not coincide with the Lauge-Hansen predictions. A common fracture pattern was observed in 8 of the 10 unclassifiable fractures, which included a high spiral fracture of the fibula, vertical shear fracture of the medial malleolus, posterior malleolar fracture, and complete tears of the anterior–inferior tibiofibular ligament and the interosseous membrane. In addition, over 65% of patients in this series had complete ligamentous injury and a fracture of the malleolus to which the ligament attaches.
CONCLUSIONSThese results demonstrate that the Lauge-Hansen classification system may have some limitations as a predictor of the mechanism of injury and the presence of soft-tissue damage associated with ankle fractures. The identification of a novel pattern of ankle fracture also illustrates how the system fails to describe all possible fracture patterns. For these reasons, we recommend that the Lauge-Hansen system be used only as a guide in the diagnosis and management of ankle fractures and not solely relied upon for treatment decisions. Although the exact clinical implications of the variety of ligamentous injuries observed on MRI are yet to be determined, this technique may be useful in individual cases in which doubt about joint stability and soft-tissue integrity exists. Additionally, MRI may be helpful in planning surgical approaches in atypical fractures in which injury patterns are less predictable solely on the basis of x-ray.</description><identifier>ISSN: 0890-5339</identifier><identifier>EISSN: 1531-2291</identifier><identifier>DOI: 10.1097/00005131-200604000-00006</identifier><identifier>PMID: 16721242</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ankle Injuries - classification ; Ankle Injuries - complications ; Ankle Injuries - diagnosis ; Biological and medical sciences ; Diseases of the osteoarticular system ; Female ; Fractures, Bone - classification ; Fractures, Bone - complications ; Fractures, Bone - diagnosis ; Fractures, Cartilage - classification ; Fractures, Cartilage - diagnosis ; Fractures, Cartilage - etiology ; Humans ; Image Interpretation, Computer-Assisted - methods ; Injuries of the limb. Injuries of the spine ; Ligaments - injuries ; Ligaments - pathology ; Magnetic Resonance Imaging - methods ; Male ; Medical sciences ; Middle Aged ; Prognosis ; Reproducibility of Results ; Retrospective Studies ; Risk Assessment - methods ; Risk Factors ; Sensitivity and Specificity ; Traumas. Diseases due to physical agents</subject><ispartof>Journal of orthopaedic trauma, 2006-04, Vol.20 (4), p.267-272</ispartof><rights>2006 Lippincott Williams & Wilkins, Inc.</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3886-20d26866f40cc7d9aa8c30ffa3b02542df66e8b449ecafbedad09ac270fefdf73</citedby><cites>FETCH-LOGICAL-c3886-20d26866f40cc7d9aa8c30ffa3b02542df66e8b449ecafbedad09ac270fefdf73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17812658$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16721242$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gardner, Michael J</creatorcontrib><creatorcontrib>Demetrakopoulos, Demetris</creatorcontrib><creatorcontrib>Briggs, Stephen M</creatorcontrib><creatorcontrib>Helfet, David L</creatorcontrib><creatorcontrib>Lorich, Dean G</creatorcontrib><title>The Ability of the Lauge-Hansen Classification to Predict Ligament Injury and Mechanism in Ankle Fractures: An MRI Study</title><title>Journal of orthopaedic trauma</title><addtitle>J Orthop Trauma</addtitle><description>OBJECTIVESThe Lauge-Hansen classification system was designed to predict the mechanism and ligament injury patterns of ankle fractures on the basis of x-rays. The purpose of this study was to evaluate the accuracy of these predicted injury sequences using magnetic resonance imaging (MRI) in a series of patients with ankle fractures.
DESIGNRetrospective cohort.
SETTINGTwo university level 1 trauma centers.
PATIENTSFifty-nine patients with operative ankle fractures who were evaluated with both x-ray and MRI were included.
INTERVENTIONAll patients had a standard 3-view ankle x-ray series before fracture reduction, followed by an MRI. All plain x-rays were assigned to a Lauge-Hansen category by an experienced orthopedic traumatologist. MRI studies were subsequently read by an MRI musculoskeletal radiologist for the integrity of the ankle ligaments.
MAIN OUTCOME MEASUREMENTSAfter evaluation of the x-rays, fractures were classified according to the system of Lauge-Hansen, and the predicted presence, sequence, and mechanism of injury was determined. These were then compared to the actual injured structures on MRI in each case, and the ability of the Lauge-Hansen system to accurately predict the complete injury pattern was determined for the entire cohort.
RESULTSAverage patient age was 59 (range18 to 84) years. Of the 59 ankle fractures evaluated, 37 (63%) were classified as supination external rotation, 11 (19%) were pronation external rotation, 1 (2%) was supination adduction, and 10 (17%) were not classifiable on the basis of the Lauge-Hansen system. Of the 49 fractures that fit into Lauge-Hansen categories, 26 (53%) had patterns of ligamentous injury and fracture morphology that did not coincide with the Lauge-Hansen predictions. A common fracture pattern was observed in 8 of the 10 unclassifiable fractures, which included a high spiral fracture of the fibula, vertical shear fracture of the medial malleolus, posterior malleolar fracture, and complete tears of the anterior–inferior tibiofibular ligament and the interosseous membrane. In addition, over 65% of patients in this series had complete ligamentous injury and a fracture of the malleolus to which the ligament attaches.
CONCLUSIONSThese results demonstrate that the Lauge-Hansen classification system may have some limitations as a predictor of the mechanism of injury and the presence of soft-tissue damage associated with ankle fractures. The identification of a novel pattern of ankle fracture also illustrates how the system fails to describe all possible fracture patterns. For these reasons, we recommend that the Lauge-Hansen system be used only as a guide in the diagnosis and management of ankle fractures and not solely relied upon for treatment decisions. Although the exact clinical implications of the variety of ligamentous injuries observed on MRI are yet to be determined, this technique may be useful in individual cases in which doubt about joint stability and soft-tissue integrity exists. Additionally, MRI may be helpful in planning surgical approaches in atypical fractures in which injury patterns are less predictable solely on the basis of x-ray.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ankle Injuries - classification</subject><subject>Ankle Injuries - complications</subject><subject>Ankle Injuries - diagnosis</subject><subject>Biological and medical sciences</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Fractures, Bone - classification</subject><subject>Fractures, Bone - complications</subject><subject>Fractures, Bone - diagnosis</subject><subject>Fractures, Cartilage - classification</subject><subject>Fractures, Cartilage - diagnosis</subject><subject>Fractures, Cartilage - etiology</subject><subject>Humans</subject><subject>Image Interpretation, Computer-Assisted - methods</subject><subject>Injuries of the limb. Injuries of the spine</subject><subject>Ligaments - injuries</subject><subject>Ligaments - pathology</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Traumas. Diseases due to physical agents</subject><issn>0890-5339</issn><issn>1531-2291</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFuEzEQhi0EoqHwCsgXuC3Y3l2vl1sUtTRSKhCU82rWHjduHW-xvSp5exwS6AlfRvPrG1v-hhDK2QfO-u4jK6flNa8EY5I1pasOkXxGFrw9xKLnz8mCqZ5VbV33Z-RVSneFUEyIl-SMy05w0YgF-XWzRbocnXd5TydLc2k3MN9idQUhYaArDyk56zRkNwWaJ_o1onE60427hR2GTNfhbo57CsHQa9RbCC7tqAt0Ge490ssIOs8R06cS0Otva_o9z2b_mryw4BO-OdVz8uPy4mZ1VW2-fF6vlptK10rJ8kEjpJLSNkzrzvQAStfMWqhHJtpGGCslqrFpetRgRzRgWA9adMyiNbarz8n7470Pcfo5Y8rDziWN3kPAaU6DVEVlLdsCqiOo45RSRDs8RLeDuB84Gw7Wh7_Wh3_W_0SyjL49vTGPOzRPgyfNBXh3AiBp8DZC0C49cZ3iQraqcM2Re5x8xpju_fyIcdgi-Lwd_rf1-jeiBpoT</recordid><startdate>200604</startdate><enddate>200604</enddate><creator>Gardner, Michael J</creator><creator>Demetrakopoulos, Demetris</creator><creator>Briggs, Stephen M</creator><creator>Helfet, David L</creator><creator>Lorich, Dean G</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200604</creationdate><title>The Ability of the Lauge-Hansen Classification to Predict Ligament Injury and Mechanism in Ankle Fractures: An MRI Study</title><author>Gardner, Michael J ; Demetrakopoulos, Demetris ; Briggs, Stephen M ; Helfet, David L ; Lorich, Dean G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3886-20d26866f40cc7d9aa8c30ffa3b02542df66e8b449ecafbedad09ac270fefdf73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ankle Injuries - classification</topic><topic>Ankle Injuries - complications</topic><topic>Ankle Injuries - diagnosis</topic><topic>Biological and medical sciences</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Fractures, Bone - classification</topic><topic>Fractures, Bone - complications</topic><topic>Fractures, Bone - diagnosis</topic><topic>Fractures, Cartilage - classification</topic><topic>Fractures, Cartilage - diagnosis</topic><topic>Fractures, Cartilage - etiology</topic><topic>Humans</topic><topic>Image Interpretation, Computer-Assisted - methods</topic><topic>Injuries of the limb. Injuries of the spine</topic><topic>Ligaments - injuries</topic><topic>Ligaments - pathology</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Traumas. Diseases due to physical agents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gardner, Michael J</creatorcontrib><creatorcontrib>Demetrakopoulos, Demetris</creatorcontrib><creatorcontrib>Briggs, Stephen M</creatorcontrib><creatorcontrib>Helfet, David L</creatorcontrib><creatorcontrib>Lorich, Dean G</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of orthopaedic trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gardner, Michael J</au><au>Demetrakopoulos, Demetris</au><au>Briggs, Stephen M</au><au>Helfet, David L</au><au>Lorich, Dean G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Ability of the Lauge-Hansen Classification to Predict Ligament Injury and Mechanism in Ankle Fractures: An MRI Study</atitle><jtitle>Journal of orthopaedic trauma</jtitle><addtitle>J Orthop Trauma</addtitle><date>2006-04</date><risdate>2006</risdate><volume>20</volume><issue>4</issue><spage>267</spage><epage>272</epage><pages>267-272</pages><issn>0890-5339</issn><eissn>1531-2291</eissn><abstract>OBJECTIVESThe Lauge-Hansen classification system was designed to predict the mechanism and ligament injury patterns of ankle fractures on the basis of x-rays. The purpose of this study was to evaluate the accuracy of these predicted injury sequences using magnetic resonance imaging (MRI) in a series of patients with ankle fractures.
DESIGNRetrospective cohort.
SETTINGTwo university level 1 trauma centers.
PATIENTSFifty-nine patients with operative ankle fractures who were evaluated with both x-ray and MRI were included.
INTERVENTIONAll patients had a standard 3-view ankle x-ray series before fracture reduction, followed by an MRI. All plain x-rays were assigned to a Lauge-Hansen category by an experienced orthopedic traumatologist. MRI studies were subsequently read by an MRI musculoskeletal radiologist for the integrity of the ankle ligaments.
MAIN OUTCOME MEASUREMENTSAfter evaluation of the x-rays, fractures were classified according to the system of Lauge-Hansen, and the predicted presence, sequence, and mechanism of injury was determined. These were then compared to the actual injured structures on MRI in each case, and the ability of the Lauge-Hansen system to accurately predict the complete injury pattern was determined for the entire cohort.
RESULTSAverage patient age was 59 (range18 to 84) years. Of the 59 ankle fractures evaluated, 37 (63%) were classified as supination external rotation, 11 (19%) were pronation external rotation, 1 (2%) was supination adduction, and 10 (17%) were not classifiable on the basis of the Lauge-Hansen system. Of the 49 fractures that fit into Lauge-Hansen categories, 26 (53%) had patterns of ligamentous injury and fracture morphology that did not coincide with the Lauge-Hansen predictions. A common fracture pattern was observed in 8 of the 10 unclassifiable fractures, which included a high spiral fracture of the fibula, vertical shear fracture of the medial malleolus, posterior malleolar fracture, and complete tears of the anterior–inferior tibiofibular ligament and the interosseous membrane. In addition, over 65% of patients in this series had complete ligamentous injury and a fracture of the malleolus to which the ligament attaches.
CONCLUSIONSThese results demonstrate that the Lauge-Hansen classification system may have some limitations as a predictor of the mechanism of injury and the presence of soft-tissue damage associated with ankle fractures. The identification of a novel pattern of ankle fracture also illustrates how the system fails to describe all possible fracture patterns. For these reasons, we recommend that the Lauge-Hansen system be used only as a guide in the diagnosis and management of ankle fractures and not solely relied upon for treatment decisions. Although the exact clinical implications of the variety of ligamentous injuries observed on MRI are yet to be determined, this technique may be useful in individual cases in which doubt about joint stability and soft-tissue integrity exists. Additionally, MRI may be helpful in planning surgical approaches in atypical fractures in which injury patterns are less predictable solely on the basis of x-ray.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>16721242</pmid><doi>10.1097/00005131-200604000-00006</doi><tpages>6</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Ankle Injuries - classification Ankle Injuries - complications Ankle Injuries - diagnosis Biological and medical sciences Diseases of the osteoarticular system Female Fractures, Bone - classification Fractures, Bone - complications Fractures, Bone - diagnosis Fractures, Cartilage - classification Fractures, Cartilage - diagnosis Fractures, Cartilage - etiology Humans Image Interpretation, Computer-Assisted - methods Injuries of the limb. Injuries of the spine Ligaments - injuries Ligaments - pathology Magnetic Resonance Imaging - methods Male Medical sciences Middle Aged Prognosis Reproducibility of Results Retrospective Studies Risk Assessment - methods Risk Factors Sensitivity and Specificity Traumas. Diseases due to physical agents |
| title | The Ability of the Lauge-Hansen Classification to Predict Ligament Injury and Mechanism in Ankle Fractures: An MRI Study |
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