Reduction with small pointed reduction forceps
Reduce the fracture with small pointed reduction forceps.
Drill a 1.6 mm K-wire parallel to the fibular axis into the anterior portion of the tip of the lateral malleolus using a 2.0 mm drill sleeve.
Insert the K-wire until its point reaches a minimum of 2.0 cm proximal to the antero-posterior drill hole for the wire.
Insert a second K-wire
A second 1.6 mm K-wire is inserted parallel to the first one into the posterior portion of the tip of the lateral malleolus.
These two parallel K-wires stabilize the fracture against rotation and will anchor the figure-of-eight wire distally.
Check the reduction under image intensification.
Care must be taken to avoid intraarticular insertion of the K-wires - check specifically with the image intensifier.