Fig. 2

A locking plate with an elongated oblong hole was introduced through a small incision (a). One cortical screw was introduced in the most distal hole ② of the plate and inserted into the center of the distal fibula. Another long cortical screw was inserted into the center of the proximal fragment through the elongated hole ① as distally as possible, but not completely against the plate (b). A threaded LCP drill sleeve was locked at the second locking hole ③. A bone holding clamp was used to compress the cortical screw and drill sleeve (c). One arm of the clamp (Y) held the cortical screw and the other arm (X) pulled down the drill sleeve when the clamp was compressed (white arrow). As the drill sleeve was locked on the plate, and the plate was fixed to the distal fragment, the distal fragment could be pushed downward (black arrow) and the fracture distracted (dotted arrow) when the bone holding clamp was compressed (d). Another drill sleeve was locked at the distal locking hole ⑤ to hold the plate and adjust to the longitudinal axis of the proximal fragment. A bone hook was introduced to align the distal fragment, and a reduction clamp was placed on the distal end of the fibula to restore rotation (e, f). When anatomic reduction with the correct fibular length was achieved, screws were inserted through the holes ④ while the fibular length was maintained with the clamp