With good bone quality, large infrasyndesmotic fragments of the lateral malleolus with a transverse fracture line can be fixed with a well-contoured plate under slight compression, functioning as a tension band.


Tension band principles

The tension band converts tensile forces into compression forces. The following criteria must be fulfilled for a plate to act as a tension band:

  1. The fractured bone must be eccentrically loaded
  2. The plate must be placed on the tension side
  3. The plate must be able to withstand the tensile forces
  4. The bone must be able to withstand the compressive force which results from the conversion of distraction forces by the plate.
  5. There must be a bony buttress opposite to the plate to prevent cyclic bending. The opposite cortex needs to have contact.