Lauge Hansen PAB Pronation ABduction (Eversion) Ankle Fracture

Video Description

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

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