Lauge Hansen PAB Pronation ABduction (Eversion) Ankle Fracture

© 2010
www.DrGlass.org
glass.dpm@gmail.com

With the foot in a fixed pronated position, an abductory force is placed along the medial aspect of the medial malleolus; creating either a TRANSVERSE medial malleolar fracture and/or deltoid ligament failure, this is described as a STAGE 1 injury. As the abductory force continues to push the talus laterally the talus is driven into the tibio-fibular syndesmotic joint creating injury to BOTH the ANTERIOR & POSTERIOR-inferior TIBIO-FIBULAR ligaments creating a stage 2 injury. (Note: With the interosseus ligament still intact one cannot call this a true diastasis).

In STAGE 3: The ABductory force has continued into the fibula creating a fracture at or above the ankle joint that is short and OBLIQUE on the AP view but appears transverse on a lateral x-ray.  Since the talus is driven in an inferomedial to superiorlateral direction a LATERAL SPIKE of cortex from the fibula may be visualized on an AP x-ray.  Lateral comminution is quite common. One must remember to take a Lateral x-ray of the ankle joint to adequately differentiate this fracture from the posterior spike of the fibula seen with supination external rotation injuries. This is important for fixation purposes.
 
(Take home points)
 The SHORT OBLIQUE fracture of the lateral malleolus seen in stage 3 will appear oblique on an AP x-ray, but transverse on a Lateral x-ray.  This is unique to pronation- Abduction injuries.

Project Leads:
William Hoffman
Hummira Hassani

Contributing Authors:
Julia Bernardini
Scott Crismon

Technical Advisor:
Thomas Vitale

Narration:
Matrona Giakoumis

Producer:
Nicholas Giovinco

© 2010
www.DrGlass.org
glass.dpm@gmail.com

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[DrGlassDPM]

@fboobookittyf I'm not certain if the exact mechanism has been described for his injury. I'm curious myself...

[fboobookittyf]

Buster Posey? 5/25/11

[DrGlassDPM]

@132cabrera Recovering to be able to play sports again, is not uncommon for minor or unimalleolar fractures. From what you described, it is quite possible. Certain complications which may occur, could be arthritis down the road several years.

[132cabrera]

Hey Doctor i suffered a Medial Malleolus fracture about a month ago. I didn't know it was broken until i took x-rays that day in emergency room. I had the option to just have a cast on or surgery i went with surgery since it was the most convenient for my future as Doctors said. I play soccer at a very competitive level i was just wondering if i would have a full recovery to the point where i can move around as normal or would i have certain complications.