Cleaning the fracture site
It is important to visualize and inspect the joint, searching for any bone and cartilage fragments that may have been detached from the medial malleolus or from the talus.
Reduce the fracture anatomically with the use of small pointed reduction forceps, taking care with the soft tissues.
To monitor the perfect articular reduction, a limited antero-medial arthrotomy will permit visual inspection of the joint surface.
Do not strip the periosteum more than necessary.
Insert a 1.6 mm K-wire as perpendicularly as possible to the fracture plane.
As decided in preoperative planning, this K-wire should occupy the planned position of the posterior lag screw.
Check the reduction visually (especially anteriorly) and under image intensification.