does screw order matter? a technique tip to prevent loss of fracture reduction during surgical fixation of lateral malleolus fractures

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.