The crux of treatment is the correct reduction of the lateral malleolus and fibula. Length alignment and rotation must be restored otherwise it will not be possible to reduce the talus, the syndesmosis or the Volkmann's fragment (if present).


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Proximal fibular fracture without shortening

  1. The medial malleolus is fixed (if fractured)
  2. The integrity of the syndesmosis is restored


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Proximal fibular fracture with shortening

  1. The medial malleolus is fixed (if fractured)
  2. The fibula is brought down to length and the integrity of the syndesmosis is restored


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Proximal fibular fracture with medial and posterior fracture

  1. The medial malleolus is fixed (if fractured)
  2. The fibula is brought down to length if necessary and the integrity of the syndesmosis is restored 
  3. The Volkmann's fragment is reduced and fixed