Management of Displaced Calcaneus Fractures with Medial Foot Abrasion

Initial Assessment and Management

Displaced calcaneus fractures represent a surgical challenge requiring careful management to prevent long-term disability and complications, according to the American Academy of Family Physicians 1, 2
For calcaneus fractures with displacement and medial foot abrasion, immediate attention to both the fracture and soft tissue injury is essential, as recommended by the American Academy of Orthopaedic Surgeons 3, 4
Tongue-type calcaneus fractures specifically require more urgent attention (within 24 hours) due to their potential for skin compromise, as noted by the American Academy of Orthopaedic Surgeons 4

Clean the abrasion with simple saline solution without additives (strong recommendation), as suggested by the American Academy of Orthopaedic Surgeons 3, 4
Initiate appropriate antibiotic coverage, such as Cefazolin or clindamycin (if penicillin-allergic), as recommended by the American Academy of Orthopaedic Surgeons 3
Consider additional gram-negative coverage for more severe soft tissue injuries, as noted by the American Academy of Orthopaedic Surgeons 4
Consider negative pressure wound therapy for the abrasion to promote healing, as suggested by the American Academy of Orthopaedic Surgeons 3

Once soft tissue conditions improve, proceed with open reduction and internal fixation (ORIF), as recommended by the American Academy of Family Physicians 1, 2

Consider removable cast or boot after initial immobilization period, as suggested by the American Academy of Family Physicians 1
Physical therapy to restore range of motion and strength, as recommended by the American Academy of Family Physicians 1

Surgical site infections (particularly with compromised soft tissues) are a potential complication, as noted by the American Academy of Orthopaedic Surgeons 3
Chronic pain and functional limitations are potential long-term outcomes, as reported by the American Academy of Family Physicians 1, 2