- Discussion:
- articular fracture without significant displacement;
- malleolar fractures with large plafond fragments;
- these fragments are usually posterior;
- posteroinferior tibiofibular ligament & deep transverse ligament are attached to the fragment;
- first reduce & fix fibula;
- may usually be accomplished w/ lag screw & neutralization plate;
- because of the intact state of ligamentous connection to posterior fragment, reduction of fibula usually restores length relationship of posterior plafond fragment;
- distal tibia is exposed;
- large posterior fragment needs to be identified;
- large pointed reduction forceps are placed from anterior to posterior, holding the large fragment firmly reduced;
- fixation should include lag screw placed from posteromedial to posterolateral or posterior;
- medial malleolar fragment is reduced & fixed w/ lag screw or tension band