Work

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

Year: 2026

Type: article

Abstract: Background Sneppen type V talar body fractures constitute rare, high-energy traumatic injuries typified by severe articular comminution and extensive soft-tissue compromise. Adequate surgical access is prerequisite for anatomical reduction and rigid internal fixation; however, conventional anterolateral and posterolateral approaches confer limited visualization of the posterolateral talar dome. This case report delineates the clinical utility of a syndesmosis-sparing modified combined tibiofibular osteotomy for the management of a highly comminuted Sneppen type V talar body fracture. Case presentation A 48-year-old male laborer sustained a right ankle injury following a fall from height, presenting with disabling pain, soft-tissue swelling, and restricted range of motion. Radiographic and computed tomographic (CT) evaluation confirmed a comminuted Sneppen type V talar body fracture involving the lateral and posterolateral talar dome with articular depression and displacement, concomitant with a fifth metatarsal base fracture. A single anterolateral approach was utilized to perform a combined tibiofibular osteotomy with preservation of the distal tibiofibular syndesmosis. The osteotomized segment, hinged on the intact posterior inferior tibiofibular ligament (PITFL) and posterior capsuloligamentous complex, was reflected posteroinferiorly, yielding unobstructed exposure of the lateral and posterolateral talar dome. Anatomical reduction of the talar body fragments was achieved with headless compression screws and Kirschner wires (K-wires). The osteotomy site was anatomically reduced and rigidly stabilized with two tibial lag screws and a fibular 1/3 tubular plate. A completely disrupted anterior talofibular ligament (ATFL) was anatomically repaired using a suture anchor. Postoperative imaging confirmed anatomical reconstruction. At the 3-month follow-up, the patient achieved painless full weight-bearing ambulation, with a visual analogue scale (VAS) score of 1/10 and an American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score of 88. Osseous union was radiographically evident at both the fracture and osteotomy sites. Conclusions The syndesmosis-preserving modified combined tibiofibular osteotomy represents a safe and efficacious surgical strategy for highly comminuted Sneppen type V talar body fractures. This technique affords extensive posterolateral talar dome exposure while maintaining distal tibiofibular syndesmotic integrity and mitigating iatrogenic ligamentous injury. Early functional outcomes are favorable; however, long-term surveillance is mandatory to monitor for post-traumatic osteonecrosis and secondary osteoarthritis.

Source: BMC Surgery

DOI: 10.1186/s12893-026-04079-5