Fixation of posterior malleolar fracture. A, Anteroposterior 4-mm lag screw; lag screw also is used to fix avulsion fracture. B, Lateral view of 4-mm anteroposterior lag screw. C, Multiple lag screw fixation of comminuted fracture. D, Lag screw fixation of avulsion fracture of insertion of anterior tibiofibular ligament from distal tibia. E, Posterior plate fixation. (A-D from Johnson EE, Davlin LB: Open ankle fractures: the indications for immediate open reduction and internal fixation, Clin Orthop Relat Res 292:118, 1993.) SEE TECHNIQUE 54.4.