Most medial fractures are fixed with lag screws, which should be inserted perpendicular to the plane of the fracture.
In simple transverse fractures, or in patients with good quality bone and fracture morphology in which stable reduction can be achieved, lag screw fixation is usually sufficient.
• Lag screw transverse fracture
Oblique fractures are fixed with lag screws perpendicular to the plane of the fracture.
In a vertical fracture, provided the fragment is large enough and the bone quality is good enough, two or even three lag screws on their own may be sufficient.
In vertical fractures, with a tendency to displace due to shearing forces, or if there is any concern about the strength of fixation, further support may be achieved with a buttress plate.
This may be a short plate over the apex of the fracture, with the lag screw(s) inserted inferior to the plate.
Alternatively, a longer plate may be used, with the lag screw(s) inserted through the distal end of the plate.
In fractures when the quality of the bone and the size of the bone are large enough for good fixation to be obtained with plate and screws, this is the preferred method of fixation.
If the fragment is too small, or the bone is of poor quality, tension band wiring is preferred.