Open surgical management of high energy ipsilateral fractures of the fibula and calcaneus

•Concurrent fracture of the fibula and calcaneus represents a high energy mechanism.•Safe open surgical management of the fibula and calcaneus is possible when necessary.•Knowledge of the lower extremity angiosomes allows for safe placement of surgical incisions.

BackgroundSimultaneous ipsilateral fractures of the calcaneus and fibula are the result of high-energy injuries. Open surgical treatment of both fractures can be performed with incisions based on the described blood supply of the lower extremity.MethodsA retrospective review for all patients with ipsilateral fractures of the calcaneus and fibula was performed over an eight-year period. Thirty-eight patients were identified. Eleven patients (28.9%) were treated with open reduction and internal fixation through two separate incisions. Average follow-up was 48.8 weeks.ResultsTwo patients (18.1%) required a secondary procedure. Three patients (27.2%) developed incisional cellulitis that resolved with oral antibiotics and one patient required local wound care. All fractures united.ConclusionsIpsilateral fractures of the calcaneus and fibula require open reduction and internal fixation when closed or percutaneous treatment is not appropriate. We describe an operative approach based on the angiosomes of the lower extremity that allows for treatment of these complex injuries and report the associated complications.