Classification Description Notes
Supination External Rotation Most common mechanism (40-70% of all fractures)
1 Anterior tibiofibular ligament rupture Lateral malleolar soft tissue swelling. No fracture
2 Add lateral malleolar fracture

(Weber B)

Low anterior, high posterior fracture plane
3 Add posterior tibiofibular ligament rupture or posterior malleolar fracture
4 Add medial malleolar fracture or deltoid ligament rupture
Supination Adduction Medial compression, lateral traction forces
1 Lateral malleolus fracture (Weber A)
2 Add vertical medial malleolus fracture
Pronation External rotation Deltoid ligament under stress in pronation.
1 Deltoid ligament rupture

(medial mortise widening)

2 Add anterior tibiofibular ligament rupture
3 Add spiral or oblique distal fibular fracture (Weber C)
4 Add posterior tibiofibular ligament rupture, or posterior malleolar fracture
Pronation Abduction Deltoid ligament under stress in pronation.
1 Deltoid ligament rupture or transverse medial malleolar fracture
2 Add posterior malleolar fracture
3 Add distal fibular fracture (Weber B) High lateral, low medial fracture plane

Foot position:

Supination- weight on lateral foot.

Pronation- weight on medial foot.

Abnormal forces:

Abduction- tilts lateral talus upwards.

Adduction- tilts medial talus upwards.

External rotation- outward rotation of the foot about the Z-axis



Okanobo, H., et al. (2012). “Simplified diagnostic algorithm for Lauge-Hansen classification of ankle injuries.” Radiographics 32(2): E71-84.