Lauge Hansen PER Pronation External Rotation (Eversion) Ankle Fracture

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With the foot in a fixed pronated position the forces start along the medial axis of the tibia. The leg undergoes an internal rotation creating tension on the deltoid ligament complex.
In a Stage 1 injury, one of two pathologies may occur; rupture of the deltoid ligament complex or a transverse fracture of the medial malleolus.
As the injury progresses forward into Stage 2 the talus rotates further laterally putting tension on the anterior inferior tibiofibular ligament resulting in either a rupture of this ligament or an avulsion fracture off the anterior portion of the fibula or tibia.
As the forces continue past stage 2 rupture of the interosseus membrane begins to occur distally at the level of the anke joint. The exit point of this rupture creates a Stage 3 injury, described as a high short oblique fracture of the fibula beginning above the level of syndesmois. This fracture can be at various levels on the fibula. The most proximal fracture pattern occurs at the head and neck of the fibula which is described as a Maisonneuve fracture.
If the force progress into Stage 4 either a rupture of the posterior tibio-fibular ligament or a fracture of the posterior malleolus (Volkman's fracture) will occur.
Note: The combined rupture of the anterior inferior tibiofibular ligament, the posterior inferior tibiofibular ligament, and the interosseus membrane results in a true ankle diastasis.
(Take home points)
-The injury begins along the medial axis of the tibia.
-Rupture of the interosseus membrane in conjunction with the rupture of the anterior inferior tibiofibular ligament, and the posterior inferior tibiofibular ligament creates a true ankle diastasis.
-The high fibular spiral fracture (Maisonneuve fracture) seen in stage 3 is unique to pronation external rotational injuires. It is important to always take proximal tibio-fibular x-rays when pronation external rotation injuries are suspected especially in the presence of posterior malleolar fracture with diastasis, because the high fibular fracture can be easily missed on a standard ankle x-ray series.
© 2010
www.DrGlass.org
[e-mail]
Project Leads:
William Hoffman
Hummira Hassani
Contributing Authors:
Julia Bernardini
Scott Crismon
Technical Advisor:
Thomas Vitale
Narration:
Matrona Giakoumis
Producer:
Nicholas Giovinco

[@catharsis68]

Thanks for these terrific animations and descriptions, I am a physical therapy student and having these visual aids is extremely helpful in my education.

[@catharsis68]

A tricky concept to visualize with the foot and ankle is that subtalar pronation and supination creates opposite movement in the forefoot. For example, subtalar pronation assists in creating forefoot supination. Thanks again for the great animations, and for your interest in assisting PT students such as myself.

[@DrGlassDPM]

@catharsis68 Thank you. I'm glad you found this useful. What are some other foot/ankle concepts that PT students could benefit from seeing?

[@jamespalmer4945]

Just a quick question ? Does this injury fall under the pilon catagory ?

[@vyaskashyap7974]

Good animation patients of anklets facture

[@alexdago5816]

Vyas Kashyap Kudos for the Video clip! Forgive me for butting in, I would appreciate your opinion. Have you heard the talk about - Mackorny Treat Bones Blueprint (just google it)? Ive heard some great things about it and my BF said ta ta to the frustrating Sprained Ankle stress with it.

[@artcastagno8686]

Beware: misspeak by narrator at beginning: says "internal" rotation when should be external; after that one mistake, narration is correct.