Management of Calcaneus Fractures

Initial Assessment and Fracture Classification

The mechanism of injury for calcaneus fractures typically involves a fall from height, causing axial loading through the heel, according to the American Academy of Family Physicians 1
Soft tissue status should be assessed for skin compromise, abrasions, or impending compartment syndrome, as recommended by Praxis Medical Insights 2
Tongue-type fractures require urgent attention within 24 hours due to a high risk of skin compromise, as noted by Praxis Medical Insights 2

For displaced intra-articular fractures, surgical treatment with open reduction and internal fixation (ORIF) is preferred, as it improves functional outcomes and reduces chronic pain, according to Praxis Medical Insights 2
For non-displaced or extra-articular fractures, non-surgical management with immobilization, such as cast immobilization or a fixed-ankle walker device, is appropriate, as recommended by the American Academy of Family Physicians 1

When medial foot abrasion or soft tissue injury is present, cleaning the abrasion with simple saline solution and initiating antibiotic prophylaxis, such as cefazolin, is recommended by Praxis Medical Insights 2
Applying negative pressure wound therapy to high-risk surgical incisions can reduce deep surgical site infection, as noted by the American Academy of Orthopaedic Surgeons and Praxis Medical Insights 3, 2

The optimal timing for surgery is within 2 days of injury, when soft tissues permit, and within 24 hours for tongue-type fractures to prevent skin necrosis, as recommended by Praxis Medical Insights 2
Surgery should be delayed if significant soft tissue swelling or abrasion is present, until conditions improve, according to Praxis Medical Insights 2

A removable boot may be used after initial immobilization, as recommended by Praxis Medical Insights 2
Physical therapy should focus on range of motion restoration and strength training, as noted by Praxis Medical Insights 2

Wound complications can be minimized by meticulous soft tissue handling and negative pressure wound therapy for high-risk incisions, as recommended by the American Academy of Orthopaedic Surgeons 3
Chronic pain and functional limitations occur less frequently with surgical treatment, according to the American Academy of Family Physicians 1

The American College of Radiology recommends obtaining standard radiographs including an axial Harris-Beath view as the initial imaging study for a patient presenting with a suspected calcaneum fracture, and assessing for soft tissue compromise and associated injuries 4, 5
Obtain standard three-view radiographs of the foot (anteroposterior, lateral, and oblique views) as the first-line imaging study, and add an axial Harris-Beath view specifically for suspected calcaneal fractures to determine intra-articular extent and increase diagnostic sensitivity 5
The American College of Radiology suggests adding an axial Harris-Beath view to the initial imaging protocol to determine intra-articular extent and increase diagnostic sensitivity 4, 5

The American College of Radiology advises against manipulating the ankle prior to radiographs unless neurovascular deficit or critical skin injury is present, to avoid complications 4