2025, Vol. 7, Issue 2, Part A
Conservative management of a PITFL fibular avulsion in the absence of syndesmotic instability: Case report and review of the literature
Author(s): Diego Torres-Perez, Mónica Raimundez, Jorge Cordero and Juan Luis Fayos
Abstract: Ankle fractures are commonly associated with injuries to the ligamentous structures that maintain syndesmotic integrity. The posterior inferior tibiofibular ligament (PITFL) plays a critical role in stabilizing the distal tibiofibular joint. While avulsion fractures of the PITFL at its tibial insertion (Volkmann fragment) are well documented, avulsion at the fibular insertion is exceedingly rare, and there are no prior reports of such injuries being treated non-operatively.
We describe the case of a 36-year-old male who sustained a subtalar dislocation following a motorcycle accident. A CT scan revealed multiple non-displaced fractures, including the posterior process of the talus, sustentaculum tali, and calcaneocuboid joint, along with an avulsion fracture at the fibular insertion of the PITFL. Importantly, no syndesmotic instability was detected. The patient was treated conservatively with immobilization, followed by progressive mobilization and protected weight-bearing. At 12 months, he reported a VAS score of 4 and an AOFAS score of 82.
This case highlights a rare PITFL avulsion fracture at the fibular insertion, previously described in only one case managed surgically (Patel-Sharma fragment). Unlike prior reports, our patient demonstrated no syndesmotic instability and achieved favorable outcomes with conservative treatment.
To our knowledge, this represents the first reported case of a fibular-side PITFL avulsion fracture successfully managed without surgery. We suggest that in the absence of syndesmotic instability, such injuries may be effectively treated with a non-operative approach.
DOI: 10.22271/27078345.2025.v7.i2a.258Pages: 22-24 | Views: 485 | Downloads: 154Download Full Article: Click Here
How to cite this article:
Diego Torres-Perez, Mónica Raimundez, Jorge Cordero, Juan Luis Fayos.
Conservative management of a PITFL fibular avulsion in the absence of syndesmotic instability: Case report and review of the literature. Int J Case Rep Orthop 2025;7(2):22-24. DOI:
10.22271/27078345.2025.v7.i2a.258
