1 Principles topenlarge
In B2.2 fractures there is a simple oblique fracture on the lateral side and a transverse fracture on the medial side.
As the medial fracture is an intra-articular injury, it should be fixed anatomically.
Order of fixation
The choice of fixing the medial or lateral side first may be dictated by the surgeon's preference.
Choice of implant – Lateral fixation
As this is a simple fracture a lag screw and neutralization plate is the most appropriate method of fixation.
Anatomic plates are available, and their lower profile may reduce postoperative discomfort due to prominent hardware. As these plates use locking screws, they may provide more secure fixation in osteoporotic bone.
Choice of implant – Medial fixation
Medial malleolar fractures are usually fixed with lag screws. If the fragment is too small or in poor quality bone, K-wires and tension band wiring may be better.
Note on approaches
The two following approaches are used:
2 Fixation topenlarge
Most medial fractures are fixed with lag screws, which should be inserted perpendicular to the plane of the fracture.
If the fragment is too small or in poor quality bone, K-wires and tension band wiring may be better.
As the lateral side in B2.2 fractures is a simple oblique fracture, this is usually fixed with a lag screw and neutralization plate.
Alternatively, and in particular if there is poor bone or a small fragment, an Antiglide plate may be used.
3 Check of osteosynthesis top
Check the completed osteosynthesis by image intensification.
Make sure the intra articular components of the fracture have been anatomically reduced.
Make sure none of the screws are entering the joint. This needs to be confirmed in multiple planes.