Background and purpose: Tibial avulsion fractures of PCL are common; however, the choice between open reduction internal fixation (ORIF) and arthroscopic repair of acute fractures remains controversial. We assessed the efficacy and safety of managing PCL avulsion fractures with ORIF using the posteromedial approach.Methods: This series includes 10 patients (9 males and one female) with a median age of 36 years (range 23-48 years) who underwent ORIF with a posteromedial approach for PCL avulsion fractures, with and without other knee ligamentous injuries. Bony fragments were fixed using cortical screw with a washer augmented with another backup screw fixed 3-5 cm distally. Postoperatively, the mean follow-up time was 18.8 months (range 3.5-48 months). All the surgeries were performed at a mean of 75 days (range 1-600 days) of injury, and clinical and radiological assessments were also used. Results:The patients achieved fracture union an average of 14 weeks postoperatively (range: 8-24 weeks). Two patients who sustained other ligamentous injuries demonstrated residual disability. Patients returned to work (heavy labour) within 6 months postoperatively (range: 4-9 months). Conclusion:The posteromedial approach is safe, time saving, and was not associated with complications. This approach provides stable fixation with no residual knee laxity and can be used to manage posteromedial fractures of the medial femoral condyle and tibial plateau. Further high quality studies are needed to assess this surgical approach.