- 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;
