The authors evaluate the results of a series of cases treated by surgery for fractures of the astragalus at the IInd Orthopaedic Division of the University of Pisa between 1978 and 1998. Treatment consisted in reduction and stabilization of the fractures by percutaneous route or by anterolateral approach. Prognosis for fractures of the neck worsens as the Hawkins radiographic classification of degrees increases. Based on the Hawkins clinical evaluation form, excellent and good results were obtained in 56% of cases. Radiographic evaluation confirmed the effectiveness of the Hawkins sign for the prediction of necrosis of the body; this necrosis occurred in 37.5% of cases; arthrosis of the astragalus developed in about half of the patients, which was, however, not always associated with stiffness of this joint. A stiff astragalus was the most fastidious complication, after necrosis of the astragalar body.