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Figure A
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Figure B
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Figure C
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Figure D
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Figure E
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Figure C demonstrates a transverse medial malleolus fracture with a comminuted, transverse fibula fracture above the level of the syndesmosis consistent with a pronation-abduction (PA) injury pattern. In 1950, Niel Lauge-Hansen established a classification scheme to describe rotational ankle fractures based on the position of the foot at the time of injury and the direction of the deforming force. PA patterns result in disruption of the ankle mortise in a medial-to-lateral direction. The medial malleolus or deltoid ligament fails first, followed by the anterior inferior tibiofibular ligament (AITFL), then finally the lateral malleolus. Tartaglione et al. reviewed the validity, utility, and limitations of the Lauge-Hansen classification scheme and compared it to the Danis-Weber and AO classifications. They reported that the AO and Danis-Weber classification schemes demonstrate better interobserver and intraobserver reliability for classifying fractures based on radiographs. They also noted that several later studies failed to reproduce the mechanical events and injuries originally described by Lauge-Hansen. The authors concluded that the AO and Danis-Weber classification offers more clinical utility than the Lauge-Hansen scheme. Warner et al. evaluated the ability of the Lauge-Hansen classification to predict ligamentous injuries using MRI and intraoperative findings in 300 patients. The authors found that 77% of injuries were of the supination-external rotation (SER) type and 94% of ankle fractures had ligamentous injuries consistent with Lauge-Hansen predictions. They concluded that the Lauge-Hansen classification was an accurate predictor of ligamentous injuries in patients with ankle fractures. Answer 1: Figure A demonstrates a SAD pattern with a vertical medial malleolus fracture and infrasyndesmotic fibula fracture. Answer 2: Figure B demonstrates a SER pattern with a short oblique fibula fracture at the level of the syndesmosis and a transverse medial malleolus fracture. Answer 4: Figure D demonstrates a PER pattern with a short oblique fibula fracture above the level of the syndesmosis and a transverse medial malleolus fracture Answer 5: Figure E demonstrates a pediatric Tillaux fracture with a Salter-Harris III fracture of the distal tibia epiphysis. There is a concomitant Salter-Harris II fibula fracture.
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