Evaluation and treatment of open calcaneal fractures: a retrospective analysis

The primary evaluation and management of 47 consecutive patients with 48 open calcaneal fractures was retrospectively analyzed. The fractures were treated over a 7-year period. Forty-two fractures resulted from blunt trauma, and 6 followed penetrating trauma. The predominant mechanism of injury was a motor vehicle accident. Initial treatment consisted of emergent irrigation and debridement of the open wound with intravenous antibiotic prophylaxis. Most patients underwent a second debridement. More than two thirds of the wounds were >5 cm in length, degloving-type injuries, associated with a significant neurovascular deficit and/or required a free-tissue transfer. Internal fixation of the os calcis was undertaken in 40% of patients. In addition, >40% of patients sustained concomitant foot and ankle fractures. Two patients underwent below-the-knee amputations as primary treatment. Five patients required a free-tissue transfer. Complications included two infections and one below-the-knee amputation. Two deaths occurred due to unrelated causes. Treatment standards for the optimal management of open calcaneal fractures remain controversial. A better understanding of this complex injury will help determine suitable treatment strategies.