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Principles

Order of fixation

The choice of fixing the medial or lateral side first may be dictated by the surgeon's preference. If there is significant comminution on the lateral side, the fibula must be brought out to length and the lateral malleolus returned to its anatomic position.For this reason, some surgeons prefer to fix this side first. As the medial fracture is the simpler, some surgeons prefer to fix this first.