Management of Displaced Calcaneal Fractures

Initial Assessment and Treatment

• The American College of Radiology recommends obtaining standard radiographs, including the axial Harris-Beath view, to determine the intra-articular extent of suspected calcaneal fractures 2
• Tongue-type calcaneus fractures require urgent attention within 24 hours due to potential skin compromise, according to the Praxis Medical Insights guideline 1

Immediate Medical Management

• Patients with renal dysfunction, approximately 40% of trauma patients with GFR <60 mL/min/1.73m², should be administered opioid analgesia with caution, as recommended by Anaesthesia 3
• The Anaesthesia guideline suggests prescribing paracetamol regularly unless contraindicated, and considering single-shot or continuous femoral/fascia iliaca nerve blocks for effective pain relief 3

Soft Tissue Management

• The Praxis Medical Insights guideline recommends cleaning any associated abrasions with simple saline solution without additives, and initiating antibiotic coverage with Cefazolin or clindamycin (if penicillin-allergic) 1
• Adding gram-negative coverage for more severe soft tissue injuries, and considering negative pressure wound therapy for abrasions to promote healing, are also recommended by the Praxis Medical Insights guideline 1

Definitive Treatment Strategy

• The Praxis Medical Insights guideline suggests proceeding with open reduction and internal fixation (ORIF) once soft tissue conditions improve 1
• Tongue-type fractures require more urgent intervention within 24 hours, as recommended by the Praxis Medical Insights guideline 1

Postoperative Management

• Immobilizing initially, then transitioning to a removable cast or boot, and initiating physical therapy to restore range of motion and strength, are recommended by the Praxis Medical Insights guideline 1

Complications to Monitor

• Surgical site infections, particularly with compromised soft tissues, and chronic pain and functional limitations, are common complications to monitor, according to the Praxis Medical Insights guideline 1

Special Considerations

• The Journal of the American Academy of Orthopaedic Surgeons reports that combat-related open calcaneal fractures show a 43% amputation rate, highlighting the importance of early recognition of severe soft tissue compromise and realistic expectations regarding salvage versus amputation in catastrophic injuries 4