Does Screw Order Matter? A Technique Tip to Prevent Loss of Fracture Reduction during Surgical Fixation of Lateral Malleolus Fractures

Document Type : TECHNICAL NOTE


1 Harvard Combined Orthopedic Residency Program, Boston, MA, USA

2 Cedars-Sinai Orthopedics, Los Angeles, USA

3 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


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