Practical: Lag-Screw and Neutralisation Plating of Lateral Malleolus

In an appropriately marked and consented anaesthetised patient.

I would complete the WHO checklist.

Patient would be supine on the table with sandbag under the ipsilateral limb.

Torniquet to 300mmHg

Incision 10cm in length over lateral malleolus.

Clean fracture edges

Reduce fracture with crocodile clamp

Lag screw + neutralisation plate

Closure in layers

  • Must be perpendicular to fracture site
  • Drill (3.5mm through first cortex)
  • Insert 2.5mm into proximal drill hole)
  • Drill far cortex
  • Countersink
  • Measure
  • Tap if not self tapping
  • Insert screw (screw will only engage the distal bone leading to interfragmentary ¬†compression)