Fig. 1

The surgical approach is established according to the fracture line and the displacement of the fracture fragments shown by CT scan 1 cm above the ankle joint surface. a The posterior malleolar fragment involves the tarsal tunnel, and the die-punch fragment is located laterally, using the posteromedial approach combined with the anterolateral approach. b The posterior malleolar fragment does not involve the tarsal tunnel, and the die-punch fragment is located medially, using the posterolateral approach combined with the anteromedial approach. The anterior approach is adjusted according to the position of the die-punch fragment and fracture line.