High energy comminuted C2-C3 fractures are accompanied by soft tissue injuries often treated by staged ex-fix followed by definitive ORIF. Long-term pain and traumatic OA frequently may lead to tibia-talar fusion in this subset of young patient population. The purpose of this video is to demonstrate a primary posterior tibia-talar posterior blade plate fusion technique for C2-C3 pilon fractures. Patients in our series were treated with external fixation initially, and subsequently after pin removal and pin holiday treated definitively with tibio-talar fusion as shown in the video. We have low infection and high patient satisfaction rate following these patients.