A 51-year old smoker male without relevant medical history. He was involved in a high-energy motor vehicle accident and suffered from several injuries amongst which a severely dislocated talar fracture type Hawkins IV (Fig. 3), without neurovascular compromise. Treatment consisted of open reduction followed by an external fixator to maintain adequate reposition and to monitor the soft tissues. Sixteen days post injury internal fixation was performed. X-rays six and twelve weeks post injury did not indicate avascular necrosis of the talus. After ten months a subtalar arthrodesis with a cannulated screw and iliac crest bone graft was performed because of pain caused by arthritis due to incongruent articulating surface. Rehabilitation was complicated by a wound infection. Patient did regain limited motion of the ankle joint but pain persisted. CT scans showed a non-union of the talar fracture, the vascularity of the talus could not be determined by the CT scan. After screw removal a MRI was performed. This showed an avascular talus (Fig. 4). The combination of avascular necrosis, low-grade infection and pain warranted a talectomy followed by a tibiocalcanear fusion. Six weeks after surgery patient resumed weightbearing activities. One year after tibiocalcanear fusion patient is in good physical condition and fairly pain free with transcutaneous electro neuro stimulation.