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Order of fixation

In these factures the talus is often unstable within the ankle mortise, so it may be preferable to fix the Volkmann's fragment and fibular fracture through one incision first, then fix the medial side through a medial approach.

If the surgeon prefers to fix the Volkmann's fragment with screws inserted from the anterior surface, this is usually performed after the medial and lateral side has been fixed through two separate approaches. The choice of fixing the medial or lateral side first may be dictated by the surgeon's preference.