Ankle fractures, Weber classification
- Based on location of fibular fracture relative to syndesmosis. Presumption that fracture site will be indicative of direction of energy, damage to syndesmosis.
- Guides surgical management and prognosis
| Type | Level | Notes |
|---|---|---|
| A | Below syndesmosis | No potential for syndesmotic injury |
| B | At level of syndesmosis | Potential for syndesmotic injury. Can assess for natural trajectory and presence of any shift, assess deltoid ligaments for associated injuries |
| C | Above syndesmosis | Presumption of syndesmosis and deltoid injury. Requires stabilisation of syndesmosis |
Ankle fractures, Lauge-Hansen classification
- Based on mechanical process during fracture, deforming forces applied and resultant soft tissue and bone failure pattern.
- Limited accuracy, with many studies suggesting that it doesn’t appropriately take into account the effect of axial load during the fracture event. However, it can still be a useful thought process for guiding closed reduction. Incomplete model / flawed basis.
| Mechanism | Result |
|---|---|
| Supination-adduction | Weber A fracture +/- medial malleolar fracture |
| Supination-external rotation | Weber B fracture, +/- medial or posterior malleolar fracture |
| Pronation-external rotation | Weber C fracture |
| Pronation-abduction | Weber C fracture |
Original publication Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg (1920). 1950;60(5):957-85.
Ankle fractures, AO/OTA ankle fracture classification
- Comprehensive classification based on radiographic appearance
- Combines Weber A-C, as well as considering the medial +/- posterior malleolus.
| Type | Equivalent | Subgroups |
|---|---|---|
| 44-A | Weber A | -1 lateral only, -2 lateral and medial, -3 lateral, medial and posterior (Volkmann’s) fracture |
| 44-B | Weber B | As above |
| 44-C | Weber C | As above |
Original publication Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018;32 Suppl 1:S1-S170.
Talus fractures, Hawkins classification
- Fractures through neck of talus classified by Hawkins system. Most commonly caused by axial loading and dorsiflexion, graded by degree of displacement. Is predictive of risk of talar AVN, hence grading system indicative for prognosis and management
| Type | Description | AVN rate |
|---|---|---|
| 1 | Non-displaced talar neck fracture | 0-13% |
| 2 | Talar neck fracture with subtalar subluxation or luxation | 20-50% |
| 3 | Talar neck fracture with subtalar and tibiotalar subluxation or luxation | 20-100% |
| 4 | Talar neck fracture with subtalar, tibiotalar and talo-navicular subluxation or luxation | 70-100% |
Original publication Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970;52(5):991-1002.
References
Author Contributions
Sean Griffiths, WH Resident, 2020
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.