PGI Doctor Identifies New Ankle Fracture, Names It Patel-Sharma Fracture Fragment

Chandigarh: In a groundbreaking discovery, Dr Sandeep Patel, Associate Professor in the Orthopaedics Department of Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, has identified a rare fracture pattern involving the posterior inferior tibiofibular ligament (PITFL) for the first time in the orthopaedic medical history and has proposed a new term for the new injury- Patel-Sharma Fracture Fragment. 

The research documented in the prestigious Journal of Bone and Joint Surgery, Case connector titled, "Fibular-Sided Avulsion of Posterior Inferior Tibiofibular Ligament-Patel-Sharma Fragment: A Case Report" by Dr Sandeep Patel and colleagues, describes the avulsion of the PITFL from the fibular end—a unique injury affecting ankle stability.   

PITFL is a piece of connective tissue in an ankle that helps hold the two bones of the lower leg — the tibia (the larger bone in the front) and the fibula (the thinner bone on the side) — together.

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The recent discovery is a moment of pride for the Institute and Dr Patel as he has described a new fracture fragment around the ankle for the first time in the world. This case is expected to contribute significantly to orthopaedic literature and help in the better management of complex ankle fractures worldwide.

The case involved a 30-year-old male who sustained severe injuries following a direct impact trauma. The patient suffered an open Grade 3A left proximal tibia fracture along with a transverse lateral malleolus fracture (Weber B). A detailed computed tomography (CT) scan revealed a rarely documented posteromedial tubercle fibula fracture at the PITFL insertion site, along with syndesmosis disruption.

Due to the severity of the injuries, Dr Patel and his team initially performed damage control surgery, stabilizing the patient’s leg with an external fixator. After 10 days, a definitive surgical intervention was performed, utilizing Herbert screws and a tubular plate to fix the fractures, while syndesmotic screws were used to restore joint stability.

The medical team emphasized the importance of recognizing and addressing this distinct fracture pattern. The Patel-Sharma Fragment, as they propose to name it, represents an avulsion injury of the PITFL from the fibular side, a key structure responsible for ankle stability. 

Proper fixation of this fragment is essential to prevent further instability in the ankle joint. If left untreated, such an injury can lead to long-term complications such as chronic pain, joint instability and ankle damage.

This case particularly stands out because the piece of bone that broke off from the fibula was unlike anything doctors had seen or documented before. In light of this unique finding, Dr Patel chose to name it the "Patel-Sharma Fragment" in honour of his discovery. 

When asked about his feelings regarding the significant achievement, Dr Patel told Medical Dialogues, "I’ve been specializing in Foot and Ankle for about 7-8 years, focusing on complex ankle fractures. We’ve operated on a large number of cases in India, gaining a unique perspective. Over the years, understanding of ankle fractures has significantly improved, especially with newer approaches and the importance of addressing even small fragments.

"In the last year, I developed two new classification systems for ankle fractures: the Patel-Dhillon classification for the anterior malleolus and a system for tri-malleolus fractures. One of our discoveries was a previously unnamed fragment in the ankle, which we termed the 'Patel Sharma fragment.' This was part of a complex case that we successfully treated, restoring the syndesmosis. Our findings were published in the Journal of Bone and Joint Surgery, which was a huge achievement. It wasn't until recently that I realized the significance of having a fracture named after me, especially since no Indian orthopedist has had a fracture named before," he added. 

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