1、lauge-hansen classificationand Ottawa ankle rules Author2015-11-09 AnatomyMedial Collateral Ligament Lateral Collateral Ligament Syndesmotic Ligament soft tissue boneTibia Fibula TalusATFL(anterior talofibular)PTFL(posterior talobular)CFL(calcaneofibular)AITFL(anterior-inferior tibiofibular)PITFL(po
2、stero-inferior tibiofibular)transverse tibiofibular ligaments anterior tibiotalar posterior tibiotalar tibionavicular tibiocalcaneal AnatomyStability The ankle can be thought of as a ring in which bones as well as ligaments play an equally important role in the maintenance of joint stability.If the
3、ring is broken in one place the ring remains stable.When it is broken in two places,the ring is unstable and may dislocate.lauge-hansen classificationIn 1950 Lauge-Hansen devised a classification of ankle fractures based on the position of the foot and the deforming force at the time of injury.It co
4、nsists of four types：SA SER PA PERSupination Adduction,Supination External Rotation Pronation Abduction,Pronation External Rotation ROMPronation旋前是背伸、外翻、外展的组合动作，旋前是背伸、外翻、外展的组合动作，旋前时足外侧缘抬高，内侧缘降低，旋前时足外侧缘抬高，内侧缘降低，跖朝向外侧跖朝向外侧Supination旋后是跖屈、内翻、内收的组合动作，旋后是跖屈、内翻、内收的组合动作，旋后时足内侧缘抬高，外侧缘降低，旋后时足内侧缘抬高，外侧缘降低，跖朝向内
5、侧跖朝向内侧Adduction and Abduction外展：脚掌朝向外侧，外展：脚掌朝向外侧，距骨上关节面转向内距骨上关节面转向内。内收：脚掌朝向内侧，内收：脚掌朝向内侧，距骨上关节面转向外。距骨上关节面转向外。这里所说的内收外展，是指暴力的方向。而暴力的方向都是针这里所说的内收外展，是指暴力的方向。而暴力的方向都是针对对距骨距骨而言的，距骨围绕自身前后长轴的旋转运动。而言的，距骨围绕自身前后长轴的旋转运动。Internal and External exversion同理，内、外旋指距骨相对胫骨的运动，是距骨发同理，内、外旋指距骨相对胫骨的运动，是距骨发生在水平方向的活动，距骨头向内称为
6、内旋，距骨生在水平方向的活动，距骨头向内称为内旋，距骨头向外称为外旋。头向外称为外旋。lauge-hansen分型中只有分型中只有外旋外旋，无内旋。无内旋。supination-adduction（SA）stage1.Transverse avulsion-type fracture of the fibula below the level of the joint or tear of the lateral collateral ligamentsstage2.Vertical fracture of the medial malleolusexample1supination-exte
7、rnal rotation（SER）stage1.Disruption of the anterior tibiofibilar ligamentstage2.Spiral oblique fracture of the distal fibularstage3.Disruption of the posterior tibiofibilar ligament or fracture of the posterior malleolusstage4.Fracture of the medial malleolus or rupture of the deltoid ligamentexampl
8、e2pronation-external rotation（PER）stage1.Transverse fracture of the medial malleolus or disruption of the deltoid ligamentstage2.Disruption of the anterior tibiofibular ligament stage3.Short oblique fracture of the fibular above the level of the jointstage4.Rupture of posterior tibiofibular ligament
9、 or avulsion fracture of the posterolateral tibiaexample3pronation-abduction（PA）stage1.transverse fracture of the medial malleolus or rupture of the deltoid ligamentstage2.Rupture of the syndesmotic ligaments or avulsion fracture of their insertionstage3.Short,horizontal,oblique fracture of the fibu
10、lar above the level of the jointexample4supination-adductionSAsupination-external rotationSERpronation-external rotationPER pronation-abductionPARadiographAn Algorithm2014IF：2.7311980发simplified diagnostic algorithm2012IF：2.791Test:classify the fracture belowTest:classify the fracture belowMaisonneu
11、ve fractureIn the absence of a low oblique fibular fracture,the distinction between a pronation-abduction injury and a pronation-lateral rotation force cannot be made.In this case,the entire fibula must be examned,because a fibular fracture resulting from pronation-lateral rotation injury can occur
12、anywhere from 6 cm above the tibial plafond to the fibular neck and will be missed by a routine radiographic examination of the ankle.This phenomenon was originally recognized by Maisonneuve in 1840 Danis-Weber ClassificationThe Weber system owes its popularity mainly to its simplicity.Type A occurs
13、 below the syndesmosis,which is intact.Type B is a transsyndesmotic fracture with usually partial and less commonly,total rupture of the syndesmosis.Type C occurs above the level of the syndesmosis with usually a total rupture of the syndesmosis,and consequently instability of the ankle mortise.AO C
14、lassificationA型：韧带联合平面以下腓骨骨折（韧带联合下型）A1单纯腓骨骨折A2合并内踝损伤A3合并后内侧骨折B型：韧带联合平面腓骨骨折（经韧带联合型）B1单纯腓骨骨折B2合并内侧损伤B3合并内侧损伤及胫骨后外侧骨折C型：韧带联合平面以上腓骨骨折（韧带联合上型）C1单纯腓骨骨干骨折C2复合性腓骨干骨折C3近端腓骨骨折Teaching points1.An efficient approach to classifying fractures is to identify the presence of a fibular fracture（position、orientation）
15、2.In the absence of a fibular fracture，identifying a medial malleolus fracture or medial mortise widening is the most helpful tool in classifying an ankle fracture（avulsion or compress）3.Supination external rotation is the most common mechanism of fracture，accounting for 40%-70%of all ankle fracture
16、s4.Dont miss the Maisonneuve fractureLOREMLorem ipsum dolorLorem ipsum dolorOttawa ankle rules2013IF:3.534Ottawa ankle rulesConclusions:The OAR are applicable in the Chinese population,and have high sensitivity and modest specificity for the diagnosis of fractures associated with acute ankle injury.
17、They may detect some occult fractures of the malleoli that are not visible on radiographs.Objectives:to assess the applicability of the OAR in China,to examine their accuracy for the diagnosis of fractures in patients with acute ankle sprains,and to assess their clinical utility for the detection of occult fractures.Ottawa ankle rulesThe pooled sensitivity,specificity,positive predictive value and negative predictive value of the OAR for detection of fractures of the ankle were 96.8%,45.8%,48.4%and 96.5%,respectively.supplement:age of 55 years or moreBest wishes for Best wishes for youyou
