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 integrity of the syndesmosis is restored and stabilized with one or two positioning screws.
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.