“…[8,9] Furthermore, several authors have suggested that arthritis is triggered by change in stress distribution on the articular surface, which is caused by change in the articular surface area at the distal end of the tibia and talar dome after PMF. [2,6,10] Based on biomechanical, cadaveric, and small population studies, fragment size is frequently cited as one of the main indications for fixation with thresholds for surgery ranging from 25% to 33% of the anteroposterior (AP) dimension of the articular surface. [2,[10][11][12][13] However, thus far there has not been any strong clinical evidence and no consensus.…”