Astragalus enucleation with complete bone loss is a rare pathology, and there is no current classification or treatment protocol. A 34-year-old woman sustained an open total enucleation of the talus without bone recovery in a motorcycle accident. Initially, she was treated at the emergency department with wound cleaning, surgical debridement, and external fixation with intravenous antibiotic therapy. Definitive treatment was delayed 8 weeks because of acute infection, which was treated with lavage, surgical debridement, and specific antibiotic therapy. To avoid leg-length discrepancy, we performed a tibiocalcaneal arthrodesis using a trabecular titanium spacer block with retrograde intramedullary nailing. We report satisfactory clinical, functional, and radiological results at 24 months after surgery. No complications or dysmetria was reported. We present a new way of filling this defect, which is not described in the current literature, using a trabecular titanium spacer block (indicated for revision of ankle arthrodesis of the hindfoot) together with retrograde intramedullary nailing, with promising results.