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Open fractures calcaneus, extra-articular

Last edited: 4/15/2026

Overview

Open fractures of the calcaneus (extra-articular) involve traumatic injuries where the bone is broken and exposed to the external environment without involvement of adjacent joints. These injuries pose significant risks of infection and nonunion due to their complex anatomy and location.

Diagnosis

  • Clinical Presentation: Presence of trauma history, visible bone fragments, and wound contamination 1.
  • Imaging: Radiography essential for initial assessment; CT recommended for detailed fracture pattern and comminution 1.
  • Grading: Gustilo-Anderson classification used to assess the severity based on soft tissue injury and contamination 1.

    • Management

  • Initial Care: Rapid debridement, thorough cleaning, and tetanus prophylaxis if indicated 1.
  • Stabilization: Intramedullary stabilization techniques like the spike procedure can be used for tubular bones to achieve intrinsic stability without external fixation devices 1.
  • Antibiotics: Broad-spectrum antibiotics initiated empirically, tailored based on wound culture results 1.
  • Wound Management: Negative pressure wound therapy considered for complex wounds to promote healing 1.
  • Orthopedic Fixation: External fixation or intramedullary nailing as definitive treatment, depending on fracture complexity 1.
  • Follow-Up: Regular monitoring for signs of infection, delayed union, or nonunion 1.

    • Special Populations

  • Pediatrics: Specific considerations for growth plate preservation and smaller bone size; techniques like the spike procedure may need adaptation 1.
  • Elderly: Increased risk of comorbidities affecting healing; careful assessment and management of associated conditions 1.

    • Key Recommendations

  • Utilize intrinsic stabilization techniques such as the spike procedure for open fractures of tubular bones to achieve stability without extrinsic devices (Evidence: Expert opinion) 1.
  • Implement aggressive initial debridement and wound management to reduce infection risk (Evidence: Expert opinion) 1.
  • Tailor antibiotic therapy based on wound culture results, initiating broad-spectrum coverage initially (Evidence: Expert opinion) 1.

    • References

    1 Miller WE. The spike procedure of Mumford: a simple technique is described for stabilizing open fractures of tubular bones. Clinical orthopaedics and related research 1979. link

    Original source

    1. [1]
      The spike procedure of Mumford: a simple technique is described for stabilizing open fractures of tubular bones. — Miller WE Clinical orthopaedics and related research (1979)
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