Lateral malleolar fractures are usually traumatic. Small, well-rounded fragments are occasionally seen; they are considered likely to be a form of OCD and are usually asymptomatic. Small or minimally displaced fractures may be managed conservatively. Surgical removal of fragments may result in a quicker recovery. Some fragments may be removed arthroscopically, although some require an open approach through the lateral collateral ligament of the tarsocrural joint. Larger fragments may be successfully repaired by lag screw fixation.