Lauge-Hansen classification of ankle fractures

vigente

Classifies ankle fractures by mechanism of injury.

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Escala de categorias

SER SAD PER PAD

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Procedência e vigência

Órgão emissor: Orthopedic consensus
Versão: 1950
Ano: 1950
Família: léxico
Tipo de lógica: flat
Modalidade: XR
Fonte primária: Fractures of the ankle: combined experimental-surgical and experimental-roentgenologic investigations (Lauge-Hansen)
Última verificação: 2026-06-26
Última checagem: 2026-06-26

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Mostrar a lógica estruturada (JSON)

{
  "categories": [
    "SER",
    "SAD",
    "PER",
    "PAD"
  ]
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
SER	Supination-external rotation Supination-External Rotation: foot supinated (inverted) with an external rotational force. Four progressive stages: (1) anterior tibiofibular (anterior inferior tibiofibular) ligament sprain/rupture; (2) lateral short oblique fracture of the distal fibula running anteroinferior to posterosuperior; (3) posterior tibiofibular ligament rupture or posterior malleolus avulsion; (4) transverse medial malleolus fracture or deltoid ligament disruption.	Management is stage- and stability-driven: early stages with an intact medial side (e.g. SER-II, isolated distal fibula) are stable and treated nonoperatively in a cast/boot, whereas the late stage with medial malleolus fracture or deltoid disruption (SER-IV, bimalleolar-equivalent) is unstable and treated with open reduction and internal fixation to restore the mortise.	Most common ankle-fracture mechanism. Stability tracks with stage: SER-II is generally stable; SER-IV is inherently unstable because the disrupted medial restraint no longer stabilizes the mortise, predicting poor outcome if the talus is not anatomically reduced.	okfonte Stages list from Wikipedia 'Lauge-Hansen classification', Supination-external rotation section; 'most common mechanism' (up to ~85% of ankle fractures) and stability/management (SER-II stable, nonoperative vs SER-IV unstable, ORIF) from open-access PMC3229380 (managing SER type II vs IV ankle fractures).
SAD	Supination-adduction Supination-Adduction: foot supinated (inverted) with an adductive force. Two progressive stages: (1) anterior talofibular ligament sprain or transverse/avulsion fracture of the distal fibula below the joint line; (2) vertical (near-vertical) fracture of the medial malleolus with impaction of the anteromedial distal tibial plafond.	Stage 1 (isolated low fibular/lateral injury) is generally stable and treated nonoperatively. Stage 2 adds a vertical medial malleolus fracture with possible plafond impaction - this is unstable and typically requires ORIF, with attention to buttressing the vertical fragment and elevating any impacted plafond.	Stability tracks with stage: the medial-side vertical fracture and articular impaction of stage 2 make it unstable and at risk for malreduction and post-traumatic arthritis if the joint surface and mortise are not restored.	okfonte Stages list from Wikipedia 'Lauge-Hansen classification', Supination-adduction section; general stability principle (medial-side osseous injury -> instability -> ORIF) from open-access PMC3229380 and LITFL 'Lauge-Hansen classification of ankle injury'.
PER	Pronation-external rotation Pronation-External Rotation: foot pronated (everted) with an external rotational force. Four progressive stages: (1) medial malleolus transverse fracture or deltoid ligament disruption; (2) anterior tibiofibular ligament disruption; (3) lateral fibular fracture above the level of the joint (high/spiral fibular fracture); (4) posterior tibiofibular ligament rupture or posterior malleolus avulsion.	PER injuries start with medial-side failure, so they are unstable from an early stage and usually need surgery: ORIF of the high (suprasyndesmotic) fibular fracture and medial malleolus, with syndesmotic fixation when the distal tibiofibular ligaments are disrupted (high Maisonneuve-type fractures).	Higher instability profile than SER: the early medial injury plus high fibular fracture and syndesmotic disruption produce a mortise-unstable ankle; missed syndesmotic injury risks chronic instability and arthritis.	okfonte Stages list from Wikipedia 'Lauge-Hansen classification', Pronation-external rotation section; stability/management principle (medial + syndesmotic disruption -> unstable -> ORIF + syndesmotic fixation) from open-access PMC3229380 and LITFL 'Lauge-Hansen classification of ankle injury'.
PAD	Pronation-abduction Pronation-Abduction: foot pronated (everted) with an abductive force. Three progressive stages: (1) medial malleolus fracture or deltoid ligament disruption; (2) anterior inferior tibiofibular ligament sprain/rupture; (3) transverse, often comminuted, fracture of the fibula above the level of the syndesmosis.	Like PER, the medial side fails first, so PAD injuries are typically unstable and treated operatively: ORIF of the medial malleolus and the comminuted suprasyndesmotic fibular fracture, with syndesmotic fixation when the distal tibiofibular ligaments are disrupted.	Unstable pattern: combined medial-side injury, syndesmotic involvement, and a comminuted high fibular fracture compromise the mortise and increase the risk of malunion and post-traumatic arthritis if not anatomically fixed.	okfonte Stages list from Wikipedia 'Lauge-Hansen classification', Pronation-abduction section; stability/management principle from open-access PMC3229380 and LITFL 'Lauge-Hansen classification of ankle injury'.

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