Objective To evaluate the surgical results of treating fractures of the talus posterior process via a posteromedial approach. Methods Between January 2006 and December 2008, 12 cases of fractures of the talus posterior process were treated in our department. Of them, 2 cases were complicated with a talar body fracture and 3 with subtalar dislocation. All cases were evaluated carefully with routine X-rays and CT scans pre-operatively to define the size and displacement of the bony fragments. When the conditions of soft tissue permitted, open reduction with cannulated screws was performed via a posteromedial approach. X-ray examinations were taken in the regular follow-up and functional evaluation was carried out according to the hindfoot score system of American Orthopaedic Foot and Ankle Society (AOFAS). Results Only 10 cases were followed up, with a mean duration of 18 months (12 to 48 months) . There were no wound or nerve complications. The mean postoperative AOFAS hindfoot score was 83(58 to 95) points. Secondary post-traumatic arthritis occurred after one year follow-up in 2 cases, one of which received subtalar arthrodesis due to severe pain. Conclusion The posteromedial approach is effective for fractures of the talus posterior process, because it can clearly expose the operative field to facilitate reduction and fixation and avoid the osteotomy of medial malleolus.