with syndesmotic screw fixation. Restoration of the anteromedial joint capsule of the ankle can be achieved with suturing techniques. Closed Reduction Internal Fixation (CRIF) Closed-reduction surgery requires no dissection or incisions being made into the leg to operate. It is most commonly applied in cases where the Maisonneuve fracture has only extensively damaged the anterior portion of the syndesmotic ligaments. That is, the posterior hinge of the ankle is still stable, and the foot can be internally rotated using traction to restore fibular bone length. Long-leg casting or short-leg casting is applied postoperatively to maintain this alignment. It is generally recommended that medial malleolar fractures do not require surgical intervention if closed reduction is sufficient enough for the restoration of bone length. Otherwise, large medial malleolar fractures can be fixed using trans-syndesmotic screws, figure-of-8 wires, or Kirschner wires. For smaller medial malleolar fractures, repair with a wire-tension band is sufficient enough. Complications Delaying diagnosis and treatment can result in intraoperative complications. In one case of a clinical study, conducted in 2000 and published in Orthopedics, the insertion of a super-syndesmotic screw caused the lateral malleolus to be further shifted laterally; subsequent removal of the screw was necessary. Complications that may postoperatively occur include: the development of osteoarthritis around the ankle joint. the development of peroneal nerve palsy following damage to the common peroneal nerve. extra-osseous ("outside of the bone") calcification of vessels or tissues surrounding the tibiofibular joint. Surgical hardware complications Incorrectly positioned screws can potentially make contact with articular surfaces, which can cause calcification around the affected area. Screw breakage can also cause pain in these areas. Postoperative hardware removal can cause problems such as infection, joint rigidity, or diastasis if fixation was not sufficiently long enough. In areas where residual stiffness has persisted, patients may report feeling pain or a mild aching sensation. Generally, it is recommended that hardware removal should be done anywhere from 6 weeks to 12 weeks after internal fixation to allow the tibiofibular syndesmosis to properly heal. Syndesmotic screws should be removed prior to rehabilitative training; bearing weight without prior hardware removal may result in ankle stiffness due to reduced dorsiflexion of the foot and potential screw breakage. Postoperative follow-ups Postoperative follow-ups are done to ensure that treatment has produced satisfactory results, such as checking if malreduction of any of the associated structures in a Maisonneuve fracture has occurred. Follow-ups may be performed from