A subset of C2/C3 pilon fractures, open pilon injuries, metaphyseal bone comminution, and those involving substantial soft tissue or vascular injury may be nonreconstructable. Such injuries are at risk of progress to nonunion and failing open reduction internal fixation (ORIF). The risk of infection, malunion, and nonunion is relatively high with such injury patterns. In such cases, tibiotalar arthrodesis is performed after ORIF fails as a salvage procedure. Overall, the literature agrees that all pilon fractures will develop posttraumatic osteoarthritis, and these patients are ultimately treated with an arthrodesis or in narrow population with total ankle arthroplasty. Given these combined findings, it follows that patients identified as high risk of failing ORIF could benefit from the use of primary arthrodesis. The proposed technique provides a reliable approach designed to achieve ankle fusion. It provides a means to achieve reliable union rates and spares the subtalar joint. In addition, it avoids the anterior soft tissue envelope, and hardware irritation is tempered as the final implants are covered by a muscular layer. Last, patients who are at higher risk of failing ORIF are selected and spared, having to undergo trial ORIF, time to nonunion, work absence, and rehab.