This procedure is easier to perform with cannulated screws if they are available.


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Medium sized fragments (> 25% of the articular surface) are fixed with lag screws. If the fragment is large and has a proximal extension, add more screws or a buttress plate.


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If the fragment is large and has a proximal extension, add more screws or a buttress plate.


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A small fragment (< 25% of the articular surface) with joint stability after malleolar reconstruction = fixation is not necessary.

A medium sized fragment (> 25% of the articular surface), without long proximal extension = fixation with lag screw(s).

A large fragment (> 25% of the articular surface) with long proximal extension = fixation with lag screws (+/- buttress plate).