- Discussion:
    - transverse frx of fibula occuring below syndesmosis;
    - usually there is enough remaining butress of fibula to prevent lateral talar tilt or displacement;
    - avulsion frx of distal fibula c/w supination/adduction frx;

- Treatment:
    - consider fixation w/ screw or with a tension band wire;
    - may require operative treatment if assoc w/ medial malleolus Frx;
    - tension band wire;
          - 2 parallel K wires (0.045 inch) are inserted at distal end of fibula and engage the proximal medial cortex above fracture site;
          - 20 gauge wire is then passed thru transverse drill hole above frx site & placed in a figure of 8 fashion around bent tips of protruding K wires;
    - screw fixation:
          - if frx is transverse or distal frag is small, consider insertion of a long screw across the fracture line into the meduallary canal of the proximal fragment;
          - expose tip of malleolus by splitting calcaneofibular ligament longitudinally;
          - avoiding tilting lateral malleolus toward the talus;
                    - insertion point for meduallary fixation is at lateral surface of malleolar tip;
          - 4.0 mm cancellous screw or malleolar screw is inserted into proximal medial cortex of fibula above the fracture site;
          - avoid rotation or displacement of distal fragment as screw is inserted;
          - since the medullary device (screw) is straight, the lateral malleolus may be inadvertently tilted toward the talus;
                     - this will result in narrowing of ankle Mortise & reduced motion

Percutaneous intramedullary fixation of lateral malleolus fractures: technique and report of early results.