Give it a brake: open tongue type calcaneal fracture after zip lining accident

Abstract

Tongue-type calcaneal fractures cause significant pressure on the soft tissue coverage of the posterior calcaneus, resulting in skin ischemia and necrosis. Literature shows most are fixated with ORIF weeks after the initial trauma, allowing for soft tissue stabilization. No previous case study has reported an open tongue-type calcaneal fracture that was immediately surgically corrected. This case study documents an open tongue-type calcaneal fracture that was surgically corrected immediately following a high energy trauma. A 48-year-old male had a zip lining accident where his brakes failed and he crashed into a tree feet first. The patient presented with a laceration and exposed calcaneal bone to the left lower extremity. Imaging confirmed a tongue-type calcaneal fracture with protrusion of the calcaneus. Procedures performed were incision and drainage of left heel wound, left Achilles tendon lengthening, and open reduction and temporary external fixation of left calcaneus. Surgical intervention resulted in a reduction of the left calcaneus with return to function. This case illustrates a rare occurrence with a novel fix: using an Achilles lengthening and temporary external pinning to reduce an open tongue-type calcaneal fracture immediately following the traumatic incident.