With the protection of a drill sleeve, drill a 2.5 mm hole as perpendicularly as possible to the fracture plane and parallel to the K-wire. Do not drill the far lateral cortex.
Avoid penetration of the ankle joint and the syndesmosis.
Tap cortical bone
Measure the drill depth and then tap the near cortex only with the 4.0 mm cancellous bone tap, using the protection sleeve.
Insert anterior lag screw
Insert the chosen 4.0 mm cancellous bone screw so that it comes to rest with its threads completely in main body of the distal tibia.
The use of a washer is recommended, especially in osteoporotic bone.
Insert the screw without excessive tightening.
Insert posterior lag screw
Remove the K-wire and widen its track with a 2.5 mm drill through a protection sleeve.
After measuring the length and tapping the near cortex, insert the second 4.0 mm cancellous bone screw, fitted with a washer.
Prepare plate application
Use a 3 hole one-third tubular plate to buttress this shear fracture.
Position the plate firmly by hand so that two holes lie on the main body of the tibia and one hole on the malleolar fragment. Plan the position of the first proximal screw near the fracture. This screw must be located in the main fragment, 3 mm proximal to the apex of the fracture plane.
Use the 2.5 mm drill bit and protection sleeve. Drill both cortices, but exercise great care not to over-penetrate laterally.
Measure the depth and tap both cortices with the 3.5 mm tap, using the protection sleeve.
Carefully apply the uncontoured plate. Insert the first, more distal cortex screw. By tightening the screw, the plate will act as a buttress on the distal fragment.
Finally, insert the second 3.5 mm cortex screw as described above.