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Reduction

In multifragmentary fractures, care must be taken to avoid excessive stripping of the periosteum as well as devascularization of the fragments.

Indirect reduction may be obtained by longitudinal traction, either on the foot, or of the main distal fragment using a bone hook.

In a suprasyndesmotic fracture, once the lateral malleolus is reduced in its anatomic position, it may be helpful to insert a K-wire, 30 degrees from dorsal, 2-3 cm supramalleolar.