1. The blood supply to the astragalus is relatively poor, and transcervical fractures of the astragalus interrupt this blood supply.

2. Revascularization, after injury of the astragalus, is very tardy, and hence there is a high incidence of aseptic necrosis of varying degree, noticeable particularly in the body.

3. There is the necessity of early, anatomical reduction by manipulation or by open reduction, with or without internal fixation as indicated by the stability of the fragments. The articular dome of the body must be smooth and the calcaneo-astragaloid surfaces accurately apposed.

4. In those cases in which subastragalar contact is faulty, immediate subastragalar arthrodesis is indicated to obtain earlier function and to prevent a painful weight-bearing foot. Tibio-astragalar arthrodesis is indicated when there has been demonstrable damage to these cartilage surfaces.

5. In those rare compound dislocations with minor fractures, careful cleansing, detailed débridement, coupled with the local and general administration of sulfonamide derivatives, gives a greater chance for successful conservative surgery.

6. In those compound, badly comminuted fractures, the same technique gives a reasonable chance for immediate reconstruction.

7. In certain simple or compound, but severely comminuted, fractures of the astragalus, reduction and retention of the multiple fragments is impossible. Astragalectomy or calcaneotibial arthrodesis seems a necessity.

8. Calcaneotibial arthrodesis, according to the principles outlined, would appear to offer a more satisfactory result than astragalectomy.