In isolated infrasyndesmotic transverse fractures of the lateral malleolus, because the lateral malleolar fragment includes the articular surface which articulates with the lateral aspect of the talus, there is an argument in favor of fixation.
Through an open approach, inspection and lavage of the joint can be performed and any loose osteochondral fragments removed.

Indications

  • Large distal fragment
  • Displaced, unstable fractures
  • Loss of reduction after nonoperative treatment 
  • High demand lifestyle (sport, heavy labor, etc.)

Contraindications

  • Patient not fit for surgery
  • Poor soft-tissue condition (excessive swelling, diabetes, neurovascular diseases) 
  • Functionally low demand patient

Advantages

  • Absolute stability
  • Better rotational control than in tension band wiring
  • Anatomical reduction of the joint 
  • Early functional recovery
  • Good long-term results

Disadvantages

  • Needs more dissection
  • Risk of skin breakdown 
  • Skin irritation through bulky implant 
  • Risk of intraarticular penetration by screw tip
  • Cosmetic appearance 
  • Surgical risks