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Medium sized fragments (> 25% of the articular surface) can be fixed with lag screws.

If the fragment is large and has a proximal extension, it may be desirable to add a buttress plate. This can only be performed through a posterior approach.


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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 screw and buttress plate.