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Insert the posterior K-wire

Using 1.6 mm K-wire, drill the posterior wire as perpendicularly as possible to the fracture plane.

Take special care not to cross the fracture line too close to the joint.

Note
Avoid penetration of the ankle joint, or the lateral tibial cortex.


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Insert the anterior K-wire

A second 1.6 mm K-wire is inserted into the medial malleolus, parallel to the first wire.

These two K-wires stabilize the fracture against rotation and will be used to anchor the figure-of-eight wire distally.

Check the reduction under image intensification.

Note
Care must be taken to avoid intraarticular positioning of the K-wires.