Abstract
We evaluated the accuracy of the predictive injury sequences of the Lauge-Hansen (L-H)
classification using magnetic resonance imaging (MRI) in patients with ankle fractures
and determined the possible causes of mismatch. Sixty-five patients with ankle fractures
who had a complete series of anteroposterior, lateral, and oblique radiographs and
ankle MRI studies available were included. The fracture pattern was assigned by 2
senior orthopedic surgeons according to the L-H classification system. The syndesmotic
ligaments, lateral collateral ligaments, and medial deltoid complex ligaments were
evaluated on the preoperative MRI scans. Comparisons were performed between the predicted
ankle ligamentous injury based on the radiographic L-H classification and preoperative
MRI analysis. Of the 65 feet in 65 patients, 50 feet (76.9%) were classified as having
a supination-external rotation (SER) fracture, 6 feet (9.2%) as having a pronation-external
rotation fracture, 4 feet (6.2%) as having a supination adduction fracture, and 2
feet (3.1%) as having a pronation abduction fracture. The overall compatibility of
the radiologic classification with the MRI classification was 66.1%. In the evaluation
of 50 feet with the MRI SER designation, maximum compatibility was found for stage
4 (77.3%). The main cause for the discrepancy in the SER designation was missing the
presence of deltoid ligament disruption on the plain radiographs, especially in the
stage 2 and 3 SER fracture pattern. In the evaluation of deltoid complex injuries,
all injuries were localized to the anterior part of the medial deltoid complex. The
validity of the L-H classification system was low. A new classification system is
needed to address the medial malleolus fracture or deltoid complex injuries without
posterior injury. Also, stress radiographs could be added to standard radiographs
for the classification to address deltoid complex injuries.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: April 19, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
