Lauge Hansen PER Pronation External Rotation (Eversion) Ankle Fracture

Lauge-Hansen Pronation–External Rotation Ankle-Fracture Pattern

The video explains the Lauge-Hansen pronation–external rotation (PER) ankle-fracture pattern as a progressive injury. With the foot fixed in pronation, external-rotation forces travel through the ankle and damage structures in a typical sequence.

Injury Progression

1. Stage 1 — Medial injury

   • The force begins along the medial side of the tibia while the leg internally rotates.
   • This places tension on the deltoid ligament complex.
   • The injury may be a deltoid-ligament rupture or a transverse fracture of the medial malleolus.

2. Stage 2 — Anterior syndesmotic injury

   • The talus rotates farther laterally.
   • The anterior inferior tibiofibular ligament (AITFL) may rupture, or an avulsion fracture may occur from the anterior fibula or tibia.

3. Stage 3 — Interosseous membrane and fibular fracture

   • The interosseous membrane begins to rupture near the ankle.
   • The resulting fibular fracture is typically a high, short-oblique fracture above the syndesmosis, though its height can vary.
   • In the most proximal pattern, the fracture involves the fibular head or neck and is called a Maisonneuve fracture.

4. Stage 4 — Posterior injury

   • Further progression may rupture the posterior inferior tibiofibular ligament or fracture the posterior malleolus, also called a Volkmann fracture.

Key Takeaways

• The injury begins medially and progresses through the syndesmosis toward the fibula and posterior ankle.
• Combined disruption of the AITFL, posterior inferior tibiofibular ligament, and interosseous membrane produces a true ankle diastasis.
• A high fibular spiral fracture, including a Maisonneuve pattern, is characteristic of pronation–external rotation injuries.

Speakers and Sources

• Speaker: One instructional narrator; not identified in the subtitles.
• Source: Video from the DrGlassDPM channel.