Tongue-type calcaneus fractures: a threat to skin
Calcaneal fractures account for 60% of all tarsal bone fractures. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. They are often superiorly displaced because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex.
Skin compromise complicates a large percentage of these injuries because of the thin layer of soft tissue and superficial nature of the fracture. Early recognition by the emergency physician and prompt operative repair prevent further injury and obviate the need for surgical soft tissue coverage or potential amputation.
Am J Emerg Med. 2013 Jul;31(7):1151.e3-4.
Calcaneal tongue-type or“beak” fracture
This unusual displaced calcaneal fracture can be intra- or extraarticular. The most important feature of this fracture is its association with significant soft-tissue injury and potential soft-tissue complications. Because of marked disruption of the posterior soft tissues, if it does not present as an open fracture at the time of admission to hospital, the pressure from within on the posterior skin will soon cause it to break down and convert it into an open fracture.
This fracture occurs as a result of the Achilles tendon, which is extremely strong, avulsing a posterior fragment which may be either intra- or extraarticular. Occasionally, it is completely extraarticular but deserves the same operative treatment and reduction. If it is not reduced accurately, weakness from Achilles tendon dysfunction will occur.
"Tongue-type" calcaneal fractures
"Tongue-type" calcaneal fractures that demonstrate blanching of the skin, or partial- or full-thickness skin breakdown, require emergent treatment.
Early recognition by the emergency physician and prompt operative repair prevent further injury and obviate the need for surgical soft tissue coverage or potential amputation.
The Journal of Emergency Medicine Volume 52, Issue 1, January 2017, Pages 28–33.