A method is described that requires a minimum of operating time, is direct in its surgical approach, and is simple to perform. Through an anterior approach to the ankle a rectangular cross section of the weight-bearing portion of the ankle joint is excised en bloc to within 0.6 centimeter of the posterior cortices. Enough of the plafonds of the talus and tibia are preserved to maintain the "fit" of the talus in the mortise. One or more autogenous bone grafts are inserted into this cavity so that cancellous bone adjoins cancellous bone on all surfaces of the prepared osseous bed. Internal fixation is used when instability is demonstrated. The limb is immobilized in a plaster cast for eight weeks or longer until union is solid. A primary fusion was obtained in sixteen of eighteen patients. Shallow placement of the graft was the apparent cause of pseudarthrosis in two patients.