Posttraumatic malalignment after talar neck fractures invariably leads to painful functional impairment. Anatomic reduction and definitive, stable osteosynthesis at the primary surgical intervention is preventative. Secondary anatomic reconstruction with joint preservation should be considered in the absence of arthrosis in the peritalar articulations. Reorientating arthrodeses should be entertained where deformity has resulted in joint incongruity and, ultimately, posttraumatic arthritis. TAA may have a role as a motion-conserving procedure in combination with adjacent subtalar and midtarsal fusions.