• Vertical fracture line
  • Displaced, unstable fractures of the medial malleolus
  • Open fractures 
  • Severe soft-tissue injury 
  • Surgeon's preference


  • Poor general condition of the patient (high anesthetic risk) 
  • Low demand patient 
  • Poor quality of soft tissues
  • Peripheral vascular diseases 


  • Buttressing effect against displacement of the fragment by a shearing force, particularly where it is felt that simple screw fixation may give inadequate hold
  • Absolute stability
  • Anatomical reduction of the joint
  • Early functional recovery 
  • Good long-term results 


  • Longer incision because of the plate
  • More dissection needed
  • Risk of skin irritation caused by the plate
  • Risk of wound infection 
  • Risk of soft-tissue breakdown 
  • Cosmetic appearance