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Because of the anatomical and functional peculiarities of the astragallus surgical and conservative treatment of central fractures are often unsatisfactory. A follow-up study of 40 patients with 42 central talus fractures were performed over an average of 9 years after the initial trauma. The number of poor results was extremely high; only primary surgical or conservative treatment showed good or fair results. Best results were obtained by primary surgical treatment whereas fractures operated at later stages showed worse results. Therefore fresh central astragallus fractures should be operated upon, fractures older than 1 day should be treated conservatively. If a satisfactory reduction cannot be obtained, the fracture should be operated upon in order to prevent arthrosis in the upper ankle joint.