Surgical management of open calcaneal fractures

Background. Open calcaneal fractures represent a group of rare injuries which should be treated by an interdisciplinary experienced team of surgeons. The degree of soft tissue damage determines the surgical therapy of the fracture. Classification. Calcaneal fractures are classified according to the internationally recognized system proposed by Sanders, while the accompanying soft tissue damage is classified according to Gustilo and Anderson. Therapy. Emergency treatment includes wound debridement and immobilization with an external fixator. Until the soft tissue situation is under control, further revision procedures might be necessary. Internal definitive osteosynthesis should be carried out up to 3 weeks after trauma, when wound closure can be accomplished simultaneously or carried out within a further 48 h of the operation. In some cases flap coverage might be required. Whenever internal fixation is not possible, external fixation should aim at a reduction according to the length, axis and rotation of the calcaneus. External fixation should be maintained as a hinged fixator to allow passive and active motion in the ankle and the subtalar joint.