Approach to the Lateral Malleolus

Short lateral incision over the distal fibula for a Weber B fracture, with the fracture exposed and held with a reduction clamp — Short lateral incision over the distal fibula for a Weber B fracture, with the fracture exposed and held with a reduction clamp. Image from Yoshimoto K, Noguchi M, Koseki T, Tominaga A, Okazaki K. Comparative effectiveness of nitinol staple-only fixation versus antiglide plate fixation for Weber type B distal fibular fractures. BMC Musculoskelet Disord. 2025, 26(1), 572. CC BY 4.0.

Approach to the Lateral Malleolus, radiograph of ankle fracture fixation with a lateral plate — Radiograph of ankle fracture fixation with a lateral plate. Image by Nicolai.Berger, Wikimedia Commons, CC BY-SA 4.0.

Aims

Exposure of the lateral malleolus

Indications

Fracture Fixation

Position

supine
sandbag under buttock
exsanguinate
tourniquet

Landmarks

subcutaneous surface of fibula
lateral malleolus

Incision

10-15cm incision along posterior margin of fibula

Internervous Plane

None
More proximally
- Peroneus tertius deep peroneal nerve
- Peroneus brevis superficial peroneal nerve

Superficial Dissection

Elevate skin flaps
- Beware
  - Short saphenous vein
  - Sural nerve

Deep Dissection

Incise periosteum
Beware
- Terminal branches of peroneal artery

Dangers

Sural nerve
Terminal branches of peroneal artery

Procedure

Proximal
- Posterior border of fibula
Distal
- Curve incision over lateral side of foot
  - Identify peroneal tendons & incise peroneal retinaculum
  - Detach fat pad from sinus tarsi
  - Detach origin of EDB to expose CC joint

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.