Executive Editor: Steve Krikler

Authors: Paulo Barbosa, Felix Bonnaire, Kodi Kojima

Malleoli Transsyndesmotic, lateral simple fracture with medial fracture

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1 Principles top


General considerations

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.

2 Patient preparation and approaches top

Patient preparation

Depending on the approach, the patient may be placed in the following positions:


Note on approaches

The two following approaches are used:

3 Fixation top


Medial fixation

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.


Lateral fixation

The lateral side is usually a simple oblique fracture, and is 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.

4 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.

v1.0 2015-12-04