Approach to the medial fracture
A medial fracture is addressed through the medial approach.
Approach to the fibular shaft fracture and syndesmosis
A direct lateral approach is used for the fibular shaft fracture. The level of the fracture dictates the level of the incision required. The distal end of the incision may need to be extended for insertion of positioning screws, or a small separate incision may be used.
Approaches to the Volkmann's fragment
If direct reduction and fixation of the Volkmann's fragment is chosen, a posterior lateral approach is used.
This incision may be extended proximally to allow access and fixation of the fibular fracture if it is relatively low. Alternatively, and more commonly, the fibular fracture is relatively high, and is approached through a separate lateral incision placed more proximally.
Alternatively, the Volkmann's fragment may be addressed with indirect reduction and anterior screw fixation through additional anterior stab incisions.