Malleolar fractures with an unstable ankle joint require additional stabilization. Different implants exist: We present the results of 135/155 patients treated with the so-called positioning screw. In 123 patients the positioning screw showed a spontaneous loosening with functional treatment and was therefore removed with the rest of the implants after eight to twelve months. In twelve cases the screw was broken. In 3/21 patients with the old 3.5 mm cortical screw with a core diameter of 1.9 mm in a correct position and in 9/113 patients with the new 3.5 mm cortical screw with inner core of 2.4 mm in an incorrect position. CONCLUSIONS Positioning screws require early removal only if they fail to loosen or if a persistent limitation of dorsiflexion is still present after three months.