Introduction Open calcaneal fractures are high-energy compression injuries that commonly result in dismal outcomes, despite appropriate care. Fracture pattern associated with these compound injuries have never been documented in detail. Plain radiographic studies and CT are imaging modalities commonly utilized to assess the fracture patterns.

Methods The roentgenographic studies of thirty-nine consectutive compound fractures treated at our University Hospital were retrospectively reviewed to evaluate fracture subtypes and incidence. Hindfoot roentgenograms were performed in all individuals; more than three-fourths of the fractures were also assessed with CT.

Results A vast array of fracture patterns was noted with variable incidence. Over 90% were intra-articular fractures. Eighty-seven percent resulted from blunt trauma - the remaining followed penetrating trauma. Six distinct fracture patterns were delineated. The fracture subtypes were stratified into low, intermediate and high levels of energy. Low energy (Type I) included minimally-displaced fractures. These comprised only eight percent of our series. Intermediate energy fractures (Type II) included tongue-type, thalamic fractures and reconstructible posterior facet fractures. These three subtypes comprised 69% of the series. Finally, the Type III, or high-energy fractures was made up of “pulverized fractures” and fracture-dislocations. These comprised 23% of our series.

Conclusions Stratification of injury severity based on fracture subtypes and wound characteristics should assist orthopedists treating these compound hindfoot injuries. An injury classification is proposed combining a three part “energy of injury” scheme with a two-part “soft tissue” classification. A fuller understanding of the injury subtypes should help establish future management standards.