SER V Lauge Hansen: A new ankle fracture pattern?

Lauge Hansen classification is the commonly followed classifi- cation for ankle fractures. It consists of 2 components; the first is the position of the foot at the time of injury and second is the direc- tion of force causing the injury. SER-Supination external rotation is the most common pattern and is further divided into 4 stages with increasing severity. SER fracture is associated with a classical fracture pattern in fibula—a Weber B type fracture extending from posterior to anterior from proximal to distal direction. SER IV stage is associated with medial injury—either medial malleolar fracture or deltoid ligament injury.
Recently, we had a run of cases with ankle fracture disloca- tions following severe wintery conditions. Three of these showed an interesting fracture pattern. A typical SER ankle fracture was associated with a spiral fracture of distal tibia as a separate entity.
In both the cases the tibial fracture was extending superolaterally to inferomedially.
All these were due to a slip in snow causing a significant fracture dislocation indicating a high energy injury.
We propose that the same force that caused the ankle fracture after sequentially causing anterior, lateral, posterior and medial injury at ankle level propogates in a sequential manner proximal to ankle leading to this peculiar fracture pattern. We have called this type SER V fracture pattern.
In two of these, after fixing the fibular fracture in usual manner with a leg screw and a neutralization plate, a distal tibial plate was used to fix the tibial fracture, while in third case due to extensive blisters, medial malleolus was fixed percutaneously, managing the tibial fracture conservatively. We would like to discuss the biome- chanics of this new fracture pattern and various treatment options.