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Figure A
6%
171/2800
Figure B
16%
449/2800
Figure C
5%
129/2800
Figure D
71%
1980/2800
Figure E
2%
55/2800
Select Answer to see Preferred Response
Figure D shows a pronation abduction ankle fracture according to the Lauge-Hansen classification. This injury pattern is associated with a comminuted fibula fracture above the level of the syndesmosis and frequently has a concominant syndesmotic injury. Lauge-Hansen's classic article describes in detail his proposed classification of ankle fractures based on both the position of the foot (supination or pronation) and an externally applied deforming force (adduction, abduction, external rotation). The Lauge-Hansen classification system is based on cadaveric experiments using manually applied forces and roentographs performed at each stage of injury. Edwards and DeLee review their results in managing diastasis of the tibiofibular joint without an associated fracture. The authors propose a classification system of this uncommon injury and and theorize that the injury results from a pronation abduction mechanism. Incorrect Answers: Answer 1: Figure A represents a supination adduction fracture based on the vertical medial malleolar fracture, medial dislocation on the talus, and low transverse fibula fracture. Answer 2: Figure B represents a pronation external rotation injury; note the high oblique fibula fracture and corresponding transverse medial malleolus fracture. Answer 3: Figure C represents a supination external rotation ankle injury based on the oblique fibula fracture at the level of syndesmosis and the associated transverse medial malleolar fracture. Answer 4: Figure E represents a pilon fracture based on the significant articular comminution signifiying an axial loading mechanism instead of a rotational injury.
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