Delayed Soft Tissue Necrosis in an Atypical Closed Calcaneal Fracture: A Case Report

Calcaneal fracture is the most common foot fracture. It occurs due to an axial load and is associated with high morbidity, especially when the articular surface is involved. There are two types of calcaneal fractures: Joint depression type and tongue type. The latter has a high risk of skin necrosis and should be operated on promptly.

This is a 37-year-old Bangladeshi man who sustained a comminuted calcaneal fracture and a Lisfranc fracture of the left foot. Initial radiograph showed a joint depression-type fracture, excluding a surgical emergency. Nevertheless, the patient developed skin necrosis over the posterior aspect of the heal that improved after open reduction and internal fixation of the calcaneus. Pre-operative computed tomography (CT) scan demonstrated a bony fragment that was displaced posteriorly causing the skin necrosis.

X-ray imaging is not sufficient to exclude surgical emergencies with calcaneal fractures. Highly comminuted fractures should be assessed more thoroughly with urgent CT scan.