Talar head and fracture injuries are not easily recognized and can create significant long-term disability when missed. Careful investigation of any injury about the ankle requires both clinical and radiographic examination. A computed tomography scan is extremely helpful in diagnosing and treating talus fractures. Displaced fractures require open reduction of the major joint surfaces and internal fixation. Prolonged non–weight bearing and immobilization is the norm. Despite aggressive management, complications involving avascular necrosis and posttraumatic arthritis to both the subtalar and tibiotalar joints occurs frequently.