| Outbound Relationships | Type | Target | Active | Characteristic | Refinability | Group | Values | 
| Open reduction of fracture of tibia and fibula with internal fixation | Is a | Open reduction of fracture of tibia with internal fixation | false | Inferred relationship | Existential restriction modifier |  |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Is a | Open reduction of fracture of fibula with internal fixation | false | Inferred relationship | Existential restriction modifier |  |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site | Bone structure of tibia | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Using | Orthopedic internal fixation system, device | false | Inferred relationship | Existential restriction modifier |  |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Surgical repair - action | false | Inferred relationship | Existential restriction modifier |  |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site | Bone structure | false | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct device | Orthopedic internal fixation system, device | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Using | Orthopedic internal fixation system, device | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 5 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 5 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site | Bone structure | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site | Bone structure | false | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Indirect | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Indirect | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Indirect | Bone structure of tibia | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Indirect | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Indirect | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Indirect | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Indirect | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Indirect | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Indirect | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Direct | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Direct | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Direct | Bone structure of fibula | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Indirect | Bone structure | false | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Direct | Bone structure | false | Inferred relationship | Existential restriction modifier | 5 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Direct | Bone structure of tibia | true | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Using device | Orthopedic internal fixation system, device | false | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Using device | Orthopedic internal fixation system, device | false | Inferred relationship | Existential restriction modifier | 6 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Using device | Orthopedic internal fixation system, device | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Using device | Orthopedic internal fixation system, device | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture, closed | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Reduction - action | false | Inferred relationship | Existential restriction modifier | 6 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 5 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 5 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 6 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 5 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 6 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Access | Open approach - access | false | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Is a | Open reduction of fracture with internal fixation | false | Inferred relationship | Existential restriction modifier |  |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Is a | Open reduction of fracture of tibia and fibula | true | Inferred relationship | Existential restriction modifier |  |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Direct | Bone structure of lower limb | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | true | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Open reduction - action | true | Inferred relationship | Existential restriction modifier | 1 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Open reduction - action | true | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | true | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Direct | Bone structure of fibula | true | Inferred relationship | Existential restriction modifier | 2 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Using device | Orthopedic internal fixation system, device | false | Inferred relationship | Existential restriction modifier | 3 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Is a | Open reduction of fracture of tibia with internal fixation | true | Inferred relationship | Existential restriction modifier |  |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Is a | Open reduction of fracture of fibula with internal fixation | true | Inferred relationship | Existential restriction modifier |  |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Direct | Bone structure of tibia | true | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | true | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Using device | Orthopedic internal fixation system, device | true | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | true | Inferred relationship | Existential restriction modifier | 4 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Procedure site - Direct | Bone structure of fibula | true | Inferred relationship | Existential restriction modifier | 5 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Method | Fixation - action | true | Inferred relationship | Existential restriction modifier | 5 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Using device | Orthopedic internal fixation system, device | true | Inferred relationship | Existential restriction modifier | 5 |  | 
| Open reduction of fracture of tibia and fibula with internal fixation | Direct morphology | Fracture | true | Inferred relationship | Existential restriction modifier | 5 |  |