A Cadaver Study Revisiting the Original Methodology of Lauge-Hansen and a Commentary on Modern Usage

John Y. Kwon, MD; Ida Leah Gitajn, MD; Philip Walton, MD; Timothy J. Miller, MD; Paul Appleton, MD; Edward K. Rodriguez, MD, PhD J Bone Joint Surg Am, 2015 Apr 01


Dr. Timothy Miller, along with other professional MD's, revisited the 1950's Lauge-Hansen case study regarding the 4-stage predicted sequence of supination external rotation (SER) fractures mechanisms.

This study utilized the Lauge-Hansen methodology to determine if the predicted sequence of SER fracture mechanisms still hold true in modern medicine.


The study by Lauge-Hansen published in the Archives of Surgery in 1950 still stands as the seminal work for our understanding of the pathomechanics of ankle fractures. The purpose of the present study was to recreate Lauge-Hansen’s experiments for the supination-external rotation (SER) fracture mechanism and to determine whether the predicted sequence of osseous and soft-tissue injury is reproducible on the basis of his originally described methodology.


Ten fresh-frozen cadaver specimens amputated above the knee were utilized. The foot was axially loaded in a position of neutral dorsiflexion and supination. External rotation was applied manually in accordance with Lauge-Hansen’s description until osseous and/or soft-tissue injury occurred. Fluoroscopic images were made and anatomic dissection was performed.


Although several specimens exhibited findings consistent with certain stages of the SER injury pattern, no specimen demonstrated the complete sequence of predicted osseous and soft-tissue injury.


Loading cadaver specimens with an SER mechanism utilizing a methodology similar to that in the original experiments by Lauge-Hansen does not reliably produce the sequence of osseous and soft-tissue injury predicted by Lauge-Hansen.

Read more on the case study published at Journal of Bone and Joint Surgery.

Copyright 2015 by the Journal of Bone and Joint Surgery, Incorporated