Edited by Hayley Daniell and Matt Fury - 7/1/2021
Descriptors
Intra-articular, extra-articular, tongue type
Exam Pearls
Lower extremity neurovascular exam
Assess for skin threatening/lack of blanching/tenting, open fracture, extent of swelling
Palpate spine for tenderness
Workup
Radiographs: AP, lateral and oblique views of the ankle; Harris views if possible
Other imaging: CT with thin cuts in plane of the calcaneus
Labs: None
Other: None
Management
Need for acute intervention: Yes, immobilization without reduction
Weight-bearing and range of motion: NWB LE
Type of immobilization: Bulky Jones or well-padded short leg splint. Splint tongue-type fractures in plantarflexion with a window to monitor skin
Admission or discharge status: Admit: tongue-type fracture with skin threatening, open fracture Discharge: all others if isolated injury, with follow-up in 7-10 days for skin assessment
Anticoagulation: ASA 325mg daily if discharging, lovenox/SQH if admitting
Antibiotics: None
Surgical Indications
Absolute: Tongue-type fracture with skin threatening (urgent OR), open fracture, posterior facet or extra-articular displacement >2-3mm, anterior process fracture with >25% involvement of calcaneocuboid joint
Relative: Minimally-displaced tongue-type fracture
Not an indication: Non-displaced, small extra-articular fracture, small anterior process fracture