Extension to the lateral distal tibia (Volkmann lesion)
Option 1: Limited exposure
A sizeable Volkmann fragment may be reduced indirectly and fixed with a lag screw from anterior to posterior. When indirect reduction is not anatomical, a limited posterolateral exposure may be used to reduce and fix the fragment.
Incise the fascia parallel to the posterior border of the distal fibula as far as necessary, avoiding damage to the peritenon of the peroneal tendons.
Retract the peroneal muscles and tendons dorsally and approach the postero-lateral edge of the distal tibia directly.
Expose the fracture and elevate the periosteum only sufficiently to control reduction of the dorsal posterior tibial fragment.
Fixation of the Volkmann's fragment may be easier via a Posterolateral approach.