Summary: Subtalar dislocation is a rare injury, constituting approximately 1% of acute dislocations, and often is the result of high-energy trauma, particularly falls from heights. We present a case of a 33-year-old man who sustained a Gustilo type IIIB open subtalar dislocation when he fell 4 m from a scaffold. After irrigation and debridement, a Mitkovic distractional external fixator was applied medially for 6 weeks while the wound healed by secondary intention. Physical therapy was initiated along with partial to full weight bearing during the next 3 months. The patient returned to work at 8 months postinjury. At 24 months, the patient had a normal gait with pain only during prolonged periods of standing or walking. X-rays and MRI were normal with no signs of avascular necrosis or posttraumatic arthritis. Ankle joint range of motion was dorsiflexion 5° and plantar flexion 45° with moderately limited subtalar joint motion. The distractional external fixator allowed for complete wound care and unburdening of the talus, which perhaps reduced the possibility of avascular necrosis.