Position a four-hole, one-third tubular plate firmly by hand so that two holes lie superior and two holes lie inferior to the fracture line. Plan to position the first proximal screw near the fracture.
This screw must be located in the tibia, 3 mm proximal to the apex of the fracture.
Insertion of the proximal screws
Use the 2.5 mm drill bit and protection sleeve. Drill both cortices, but exercise great care not to overpenetrate laterally.
Measure the depth and tap both cortices with the 3.5 mm tap, using the protection sleeve.
Carefully apply the uncontoured plate and insert the first cortex screw. By tightening the screw, the plate will act as a buttress on the distal fragment.
Insert the second proximal 3.5 mm cortex screw as described above.
Insertion of the distal lag screws
With the protection of the drill sleeve, drill a 2.5 mm hole as perpendicularly as possible to the fracture plane. Do not drill the far cortex.
Care must be taken to avoid penetration of the ankle joint.
Measure the drill depth and then tap the medial cortex only with the 4.0 mm cancellous bone tap using the protection sleeve.
The 4.0 mm cancellous bone screw to be inserted should come to rest with its threads completely beyond the fracture line.
Insert the second lag screw in the same manner as described above.