Medial malleolar fracture (if present)
The ankle joint in these fractures is often very unstable. The stability is dramatically improved once the medial fracture is fixed (if present).
Most medial fractures are fixed with lag screws, which should be inserted perpendicular to the plane of the fracture.
If the fragment is too small or in poor quality bone, K-wires and tension band wiring may be better.
The multifragmentary fibular fracture must be brought out to length and is then best fixed with a bridging plate.
The integrity of the syndesmosis is restored and stabilized with one or two positioning screws. These may be inserted through the distal holes in the plate or separately from the plate.
Volkmann's fragment (if fractured)
The Volkmann's fragment may be addressed under direct vision through a posterolateral approach.
If indirect reduction of the Volkmann's fragment is chosen, sagittal lag screws are inserted through separate stab incisions.