Fibular-Sided Avulsion of Posterior Inferior Tibiofibular Ligament—Patel-Sharma Fragment

Case: A 30-year-old man presented with left proximal tibia fracture (open Grade 3A) and a transverse lateral malleolus fracture (Weber B) following direct impact injury. Computed tomography revealed a rare posteromedial tubercle fibula fracture at the posterior inferior tibiofibular ligament (PITFL) insertion, with syndesmosis disruption. Initial damage control included an external fixator. Definitive surgery, performed 10 days later, used Herbert screws and a tubular plate, along with syndesmotic screws. Conclusion: This case highlights a unique fracture pattern: PITFL avulsion from the fibular end which we wish to name as Patel-Sharma fragment . Identifying this fragment is essential as it needs to be fixed to ensure posterior syndesmosis ring stability.