Extension to the lateral distal tibia (Volkmann lesion)
If there is a combination of injuries, with a high fibular fracture and a Volkmann tibial fragment, the surgeon may choose to make two separate incisions to address each fragment independently. See Posterolateral approach and Stab incisions for anterior fixation.
Alternatively, the lateral incision may be extended distally to gain access to the Volkmann fragment.
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, use 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 posterolateral edge of the distal tibia directly.
Expose the fracture and elevate the periosteum only sufficiently to control reduction of the dorsal posterior tibial fragment.