![fibula fracture fibula fracture](http://www.southfloridasportsmedicine.com/images/Screen%20Shot%202018-01-23%20at%204_12_21%20PM.png)
The core diameter of a 3.5 mm is 2.5 mm, while that of a 4.0 mm is 2.9 mm.
![fibula fracture fibula fracture](https://userfiles.steadyhealth.com/userfiles/articles/fibula_fracture_surgery.jpg)
Higher pitch allows for more contact between the screw and the cortical bone, allowing for a more persistent attachment.
![fibula fracture fibula fracture](https://userfiles.steadyhealth.com/userfiles/articles/fibula_fracture_healing_time.jpg)
Both have a higher pitch (number of threads per inch) than large fragment screws. Either a 3.5-mm or a relatively new 4.0-mm screw, originally designed for Lisfranc injuries, is used, dependent on the size of the individual. The syndesmotic injury is addressed with one or two screws implanted just above the tibiofibular joint. It may be helpful to use a large pointed reduction clamp to “squeeze” the syndesmosis closed while placing fixation. In this case, the syndesmosis should be exposed and reduced distally, correcting fibular shortening and external rotation. If the fibula fracture is at the fibular neck, it may be better to leave the fracture unexposed to prevent iatrogenic peroneal nerve injury. The key is to restore length, rotation, and alignment of the fibula, and to provide and maintain stable fixation. If the fibular fracture is diaphyseal or metadiaphyseal, it is addressed with standard implants and techniques: one-third tubular plates, stacked one-third tubular plates, 2.7 or 3.5 DCP or periarticular plates. In these unstable injuries, the fibula must be restored to length and rotation without regard to the location of the fracture. Examine the entire calf and obtain tibia x-rays with isolated medial malleolar injuries.