Care should be taken to preserve all soft-tissue attachments (blood supply) to the talar body.
Two approaches should be used.
When the combined approaches are used and the reduction can not be obtained, then there is a series of steps for successfully obtaining the reduction.
Firstly, elevators and joysticks are advised, followed by the use of external fixators and distractors.
Lastly, the medial malleolar osteotomy would be performed as the most invasive, yet most definitive tool.
Image intensification would be used at every step.