Objective:To investigate the clinical effect of medial malleolus osteotomy, periosteal iliac bone transplantation and PRP intra-articular injection in the treatment of Hepple V intra-talus vault osteochondral injury. Methods:From January 2015 to January 2018, 23 cases of Hepple V intratalar dome osteochondral injury were treated by medial malleolus osteotomy, focal debridement, periosteal iliac bone transplantation and PRP intra-articular injection in Cangzhou Hospital of Traditional Chinese and Western Medicine. Intraoperative osteotomy through the medial malleolus revealed the internal vault of talus, cleared necrotic cartilage, removed lesions and subchondral bone cysts, and took periosteal bone embolus from the ipsilateral iliac bone. The embolus was implanted into the talus receiving area by pressing and fixing the internal malleolus osteotomy block. The changes of visual analogue scale (VAS), ankle-hind foot score (AOFAS) and range of motion (ROM) were compared before and after operation. Results:All the 23 patients were followed up for 12-36 months, with an average of 19.5 months. The VAS score was significantly lower than before, P = 0.000 (AOFAS) ankle-hind foot score was significantly higher than before, P = 0.000, ROM was significantly higher than before, P = 0.000, and no complications occurred. Satisfaction is high. Conclusion:For Hepple stage V talus cartilage injury, medial malleolus osteotomy, focal debridement, periosteal iliac bone transplantation combined with PRP injection can repair cartilage defect, relieve pain and improve joint function, which is an effective treatment method.