Indications

  • Large posteromedial fragment
  • Good bone quality
  • Displaced, unstable fractures
  • Open fractures 
  • Severe soft-tissue injury 
  • Loss of reduction after nonoperative treatment

Contraindications

  • Poor general condition of the patient (high anesthetic risk) 
  • Severe soft-tissue swelling 
  • Severely osteoporotic bone
  • Low demand patient 
  • Peripheral vascular diseases 
  • Poor quality of soft tissues

Advantages

  • Absolute stability
  • Interfragmentary compression
  • Anatomical reduction of the joint 
  • Early functional recovery 
  • Good long-term results

Disadvantages

  • Risk of fragmentation of the malleolar fragment
  • Technically demanding
  • Risk of wound infection 
  • Risk of soft-tissue breakdown 
  • Cosmetic appearance