In isolated infrasyndesmotic transverse fractures of the lateral malleolus fractures, 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

  • Distal fragment too small for plating
  • 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

  • Less dissection and less expensive compared to plating
  • Anatomical reduction of the joint 
  • Stable fixation 
  • Early functional recovery 
  • Good long-term results

Disadvantages 

  • Soft tissue irritation 
  • Risk of backing out of the K-wires 
  • Wire breakage with poor twisting technique
  • Cosmetic appearance 
  • Surgical risks