If the posterior facet is badly damaged, primary subtalar fusion is often
the best form of treatment. Locking plates may also be used for added
stability. Plate fixation across the hindfoot to the midfoot must be performed
once the hindfoot-to-midfoot relationship has been restored to normal. One must
avoid hindfoot varus, and medial, or lateral, column shortening.
These images show a primary subtalar fusion carried out as a part of treatment
of this massive talar and calcaneal injury.