We report three cases of a closed Hawkins III talar neck fracture in which the posteromedially dislocated talar body was irreducible even with combined anteromedial and anterolateral approaches. Our intraoperative solution was to proceed with a medial malleolar osteotomy, which resulted in an easy reduction. The combined incisions provided excellent exposure for anatomic reduction and rigid internal fixation. At a mean follow-up of 4 years, all fractures had healed with no evidence of avascular necrosis or talar dome collapse.