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


  • Patient not fit for surgery
  • Low demand patient 
  • Peripheral vascular disease
  • Poor state of soft-tissues 


  • Buttressing effect against displacement of the fragment by a shearing force
  • 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
  • Technically more demanding
  • Risk of wound infection 
  • Risk of soft-tissue breakdown 
  • Cosmetic appearance 
  • Surgical risks