Treatment of Acute Comminuted Fracture of the Calcaneal Body

Initial Evaluation and Imaging

Initial radiographs have limited sensitivity (87%) for calcaneal fractures compared to CT, according to the American College of Radiology 1, 2
CT without intravenous contrast is essential for proper evaluation of comminuted calcaneal fractures as it can identify occult fractures, particularly those involving the posterior facet, as recommended by the American College of Radiology 1, 2, 3
MRI without contrast may be useful for evaluating associated soft tissue injuries but is not the primary imaging modality for acute calcaneal fractures, as stated by the American College of Radiology 2, 3

Simple immobilization is appropriate when fracture fragments are small, non-articular, or minimally displaced, according to the American Academy of Family Physicians 4
Protective immobilization with a cast or fixed-ankle walker-type device is indicated for less severe fractures, as recommended by the American Academy of Family Physicians 4

Evaluate for open vs. closed fracture and assess comminution and intra-articular involvement via CT imaging, as suggested by the American College of Radiology and the American Academy of Orthopaedic Surgeons 1, 2, 5
For open fractures, immediate wound management with saline solution and early antibiotic administration are necessary, according to the American Academy of Orthopaedic Surgeons 5
For closed comminuted fractures, immobilization with cast or walker boot may be appropriate if minimally displaced and non-articular, as recommended by the American Academy of Family Physicians 4

Calcaneal fractures can be easily missed on initial radiographs; CT is essential for proper evaluation, as emphasized by the American College of Radiology 1, 2
Occult osteochondral fractures of the subtalar joint may only be visualized on CT, particularly in patients with fractures involving the posterior facet, according to the American College of Radiology 2

Weight-bearing restrictions should be maintained until radiographic evidence of healing, as recommended by the American Academy of Family Physicians 4
Physical therapy should be initiated once appropriate to restore range of motion and strength, according to the American Academy of Family Physicians 4