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Reduction

Restoring length, axis and rotation of the fibula

If the fibula is displaced, make sure it is properly reduced.

Use a small bone hook to pull the lateral malleolus distally if necessary, until perfect congruence of the distal tibiofibular joint is achieved.

Check rotation, length and antero-posterior translation of the fibula, by intraoperative radiology and/or direct visual inspection of the syndesmosis. Fix the reduction with a K-wire, if necessary.