Tibiofibular osteotomy for the treatment of Sneppen type V talar body fracture: a case report

Sneppen type V talar body fractures are rare high-energy injuries marked by severe articular comminution and severe soft tissue damage. Conventional anterolateral or posterolateral approaches fail to provide adequate visualization of the posterolateral talar dome, which impedes anatomical reduction and rigid fixation. This report introduces a syndesmosis-sparing modified combined tibiofibular osteotomy for treating severely comminuted Sneppen type V talar body fractures. A 48-year-old male laborer suffered a right ankle injury after a fall from height, accompanied by severe pain, swelling and limited ankle mobility. Radiographs and CT identified a comminuted Sneppen type V talar body fracture with lateral and posterolateral dome depression and displacement, combined with a fifth metatarsal base fracture. Via a single anterolateral incision, we performed combined tibiofibular osteotomy without damaging the distal tibiofibular syndesmosis. The osteotomized bone block, hinged by intact posterior inferior tibiofibular ligament and posterior capsule, was reflected posteroinferiorly to fully expose the posterolateral talar dome. Talar fragments were anatomically fixed with headless compression screws and K-wires, and the osteotomy was stabilized with two tibial lag screws and a fibular one-third tubular plate. The completely disrupted anterior talofibular ligament was reconstructed with a suture anchor. Postoperative imaging confirmed satisfactory anatomical articular reduction. At the 3-month follow-up, the patient achieved painless full weight-bearing ambulation with a VAS score of 1/10 and an AOFAS ankle-hindfoot score of 88. At the final follow-up, radiographs revealed complete osseous union at both the talar fracture and osteotomy sites, no radiographic signs of talar avascular necrosis (AVN), and only mild post-traumatic osteoarthritic changes. By preserving distal tibiofibular syndesmotic integrity and attenuating iatrogenic ligamentous injury, the modified combined tibiofibular osteotomy facilitates panoramic visualization of the lateral and posterolateral talar dome, rendering it a safe and efficacious reconstructive modality for severely comminuted Sneppen type V talar body fractures.