Revision 4 for 'AO/OTA classification of malleolar fractures'

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AO/OTA classification of malleolar segment fractures

The AO/OTA classification of malleolar segment fractures is one of the most frequently used systems for classifying malleolar fractures. It takes the Danis-Weber classification into account and can be correlated to the Lauge-Hansen classification.

Malleolar fractures are divided into three groups subject to the severity and complexity of the respective injury 1:

  • type A: infrasyndesmotic fibular injury
    • A1: isolated lateral malleolar injury
      • corresponds to supination-adduction injury – Lauge-Hansen stage I
      • A1.1 lateral collateral ligament injury
      • A1.2 lateral malleolus tip avulsion
      • A1.3 isolated transverse infrasyndesmotic lateral malleolar fracture
    • A2: infrasyndesmotic fibular injury and medial malleolar fracture
      • A2.1 lateral collateral ligament injury and medial malleolar fracture
      • corresponds to supination-adduction injury – Lauge-Hansen stage II
      • A2.2 lateral malleolus tip avulsion and medial malleolar fracture
      • A2.3 transverse infrasyndesmotic lateral malleolar fracture
    • A3: infrasyndesmotic fibular injury with a posteromedial fracture
      • no injury pattern in Lauge-Hansen classification
      • A3.1 infrasyndesmotic fibular injury and posteromedial fracture
      • A3.2 lateral malleolus tip avulsion and posteromedial fracture
      • A3.3 transverse infrasyndesmotic and posteromedial fracture
  • type B: transsyndesmotic fibular fracture
    • B1: isolated transsyndesmotic fibular fracture
      • corresponds to supination-eversion injury – Lauge-Hansen stage I-II
      • B1.1 simple transsyndesmotic lateral malleolar fracture
      • B1.2 transsyndesmotic lateral malleolar fracture with anterior syndesmotic rupture
      • B1.3 wedge or multifragmentary transsyndesmotic lateral malleolar fracture
    • B2: transsyndesmotic fibular fracture with medial injury
      • corresponds to pronation-abduction injury – Lauge-Hansen stage I-III
      • B2.1 anterior syndesmotic rupture and deltoid ligament rupture
      • B2.2 anterior syndesmotic rupture and medial malleolar fracture
      • B2.3 wedge or multifragmentary transsyndesmotic fracture and medial injury
    • B3: transsyndesmotic fibular fracture with medial injury and posterolateral rim (Volkmann) fracture
      • B3.1 simple transsyndesmotic fracture with deltoid rupture and Volkmann fracture
      • B3.2 simple transsyndesmotic and medial malleolar fractures and Volkmann fracture
      • B3.3 wedge or multifragmentary transsyndesmotic, medial and Volkmann fracture
    • all but type B1.1 transsyndesmotic fibular fractures can be associated with Tillaux-Chaput tubercle fractures or Wagstaffe-Le Fort avulsions
  • type C: suprasyndesmotic injury
    • C1: simple suprasyndesmotic fibular diaphyseal fracture with one of the following:
      • correspond to pronation-eversion injury – Lauge-Hansen stage I-IV
      • C1.1 rupture of the deltoid ligament
      • C1.2 fracture of the medial malleolus
      • C1.3 medial malleolar and posterior rim (Volkmann) fracture
    • C2: wedge or multifragmentary suprasyndesmotic fibular diaphyseal fracture with the following:
      • C2.1 rupture of the deltoid ligament
      • C2.2 fracture of the medial malleolus
      • C2.3 medial malleolar and posterior malleolar (Volkmann) fracture
      • C1 and C2 lesions can be additionally subcategorised in regard to syndesmotic stability
      • correspond to pronation-eversion injury – Lauge-Hansen stage I-IV
    • C3: proximal suprasyndesmotic injury with the following:
      • C3.1 medial injury: deltoid ligament rupture or medial malleolar fracture
      • C3.2 fibular shortening and medial injury
      • C3.3 medial injury and posterior malleolar (Volkmann) fracture
      • C3 fractures can be additionally subdivided in regard to proximal fibular injury (fracture/tibiofibular joint dislocation) and the medial injury (deltoid ligament rupture/malleolar fracture)

See also

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