Introduction Provides expsore to lateral malleolus posterior malleolus (requires a fracture or osteotomy in the fibula) Indications posterior malleolus fracture posterior pilon fx osteochondritis dissecans involving lateral dome of talus osteochondromatosis of ankle Approach Position supine with bump under buttock exsanguinate leg Incision begin incision 12 cm proximal to tip of lateral malleolus extend distally along posterior margin of fibula curve anterior following course of peroneal tendons end 2cm below and 2 cm anterior to tip of lateral malleolus Superficial dissection subperiostally expose the fibula incise sheaths of peroneal tendons and displace tendons anteriorly Deep dissection if fibula is not fractured perform osteotomy 10 cm proximal to tip divide interosseous membrane, and anterior and posterior tibiofibular ligaments careful to preserve calcaneofibular and talofibular ligaments rotate distal fibula to expose lateral and posterior aspects of the distal tibia if performing in children be careful not to damage the distal fibular physis Repair fibula with syndosmosis screw from proximal part of the lateral malleolus through the tibiofibular syndesmosis overdrill fibula to close down syndesmosis