The patient identified the bilateral ankles as the operative site. Consent was verified for the procedure. The patient was brought back and placed under general anesthesia. All bony prominences were subsequently padded as the patient was given 2 g of Ancef IV 30 minutes prior to starting the case. Bilateral lower extremities were prepped with sterile ChloraPrep and draped in sterilely appropriate fashion. Surgical procedure began with passing a guidewire percutaneously over the lateral aspect of the left ankle to engage the distal fibula. Intraoperative fluoroscopic imaging confirmed the appropriate starting position. The guidewire was then passed across the fracture while the fibula was maintained in reduced position with the manual reduction techniques. The outer cortex was breached and the screw was countersunk and a 5.5 cannulated screw was placed in the left fibula. Attention was then focused on the medial malleolar fractures. Percutaneous guidewires for 4.0 cannulated screws were placed; 4-0 cannulated screws were placed and intraoperative fluoroscopic imaging confirmed anatomic reduction and alignment. Intraoperative cotton test was negative for the left ankle. The surgical incisions were closed with sterile 2-0 nylon suture in Donati suture fashion.

Attention was then focused on the right ankle. A guidewire was passed up the fibula while the displaced fibula fracture was maintained with manual reduction techniques. The outer cortex was breached and countersunk as a 5.5 cannulated screw was placed, achieving rigid internal fixation. 4.0 stainless steel cannulated screws were then percutaneously placed across the medial malleolus achieving rigid internal fixation. Again, the surgical wounds were closed with sterile 2-0 nylon suture.