John Zhao - Harvard Combined Orthopedic Residency Program, Boston, MA, USA
Max Michalski - Cedars-Sinai Orthopedics, Los Angeles, USA
Eitan Ingall - Harvard Combined Orthopedic Residency Program, Boston, MA, USA
Philip Grisdela - Harvard Combined Orthopedic Residency Program, Boston, MA, USA
John Kwon - Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA

When obtaining surgical fixation of lateral malleolus fractures, a cortical lag screw is commonly used to obtain anatomic reduction. Subsequently, a neutralization plate is applied. Slight loss of fracture reduction after plate placement occasionally occurs. Although this is frequently attributed to poor bone quality or suboptimal initial lag screw fixation, a frequently overlooked factor is screw order when applying the neutralization plate. The purpose of this technique tip is to highlight the biomechanical rationale behind this loss of reduction and advocate a specific screw order for lateral malleolus fixation. Level of evidence: V

Ankle fracture, Biomechanics, lateral malleolus fracture, screw order