Some surgeons prefer two small fragment screws as syndesmotic screws, especially in high fibular fractures, such as the Maisonneuve injury.
Prepare and insert the second positioning screw as described above, parallel to, and 1.5–2 cm proximal to, the first screw.
Once satisfactory reduction and hold with screws has been confirmed, the K-wire is removed.
Intraoperative x-rays or image intensification are advised, to conﬁrm the position of the screw and the distal tibiofibular joint.
Following plating of a multifragmentary fracture, or when a high fibular fracture has not been fixed, postoperative CT or MRI, to assess the rotation of the fibula at the level of the syndesmosis of both ankles, is strongly advised.