Vol. 7, Issue 2, Part C (2025)

Peritalar dislocations associated with calcaneal fractures represent an exceptionally rare and complex injury pattern, accounting for less than 1% of all dislocations and typically linked to high-energy trauma. Their severity is further amplified when combined with open wounds and midfoot fractures. This report describes the acute management of a 22-year-old female who sustained a contaminated medial plantar open wound with a complex intra-articular calcaneal fracture, varus hindfoot deformity, medial subtalar dislocation, talonavicular dislocation, and axial navicular fracture following a fall from height.
Initial evaluation demonstrated severe deformity without neurovascular compromise, and imaging confirmed the rare constellation of fractures and dislocations. Management focused on urgent debridement, reduction, and stabilization while preserving soft-tissue integrity.
Under fluoroscopic guidance, a staged reduction strategy was employed, beginning with spike-assisted maneuvering to relocate the subtalar joint. Persistent calcaneal varus was corrected using a joystick K-wire technique, after which stabilizing K-wires were inserted across the calcaneus into the talus and sustentaculum. Medial displacement of the navicular was addressed through longitudinal traction and forefoot abduction, enabling talonavicular reduction, followed by retrograde K-wire fixation. Vacuum-assisted closure was applied over the open wound to optimize conditions for subsequent skin grafting.
This case highlights the importance of early recognition, aggressive debridement, and innovative percutaneous reduction techniques in managing severe peritalar injuries, especially when soft-tissue compromise limits extensive open reconstruction. The combination of spike-assisted reduction, correction of hindfoot alignment, and strategic K-wire stabilization provided effective temporary fixation while minimizing additional soft-tissue trauma. Although initial outcomes were favorable with progressive granulation and stable alignment, long-term prognosis remains guarded due to the high risk of subtalar arthritis inherent to such injuries. Continued follow-up is essential to monitor union, hindfoot mechanics, and functional recovery.