Dr Papineau Meets Dr Masquelet—Management of Open Calcaneal Fractures, Combining Two Techniques: A Case Report

Aim and background: Open fractures of the calcaneum are often the source of significant morbidity due to the high rate of wound infection and significant morbidity, ranging from malunion to amputation. The outcome depends upon multiple factors. The use of well-established techniques such as Masquelet and Papineau in open fracture calcaneum results in good outcomes. Case description: A 68-year-old male with a 6-day-old history of trauma presented to us with multiple fractures, including Gustilo–Anderson type IIIB open calcaneum fracture with Sanders type IV fracture pattern, and was managed with a staged procedure. Initial debridement resulted in a soft-tissue defect of 4.5 × 2.5 cm wound over the medial side. Fracture was reduced after debridement and provisionally fixed with K-wires. There was a void in the calcaneum, which was filled with an antibiotic-mixed cement spacer. At 3 weeks, cement spacer was removed, void was filled with bone graft (autograft mixed with allograft), and K-wire was replaced with screws to achieve subtalar arthrodesis and final fixation. Wound on the medial side remained open. It was followed with interval dressing, and finally a split-skin graft was done after 2 weeks of second surgery. The wound finally healed. There was no recurrence of infection and fracture consolidated well with reasonably good length and height of calcaneum, and subtalar arthrodesis was achieved. A good outcome was finally achieved with a stable and shoeable foot at the final follow-up. Conclusion: A good outcome in our case was the result of the utilization of well-established techniques and principles of orthopedics. Well-established techniques such as Masquelet and Papineau can be used in open calcaneum fractures with good results; this can help us to avoid severe complications such as osteomyelitis and amputation, and also highly demanding surgery such as free flap can be avoided. Clinical significance: The use of Masquelet and Papineau techniques can be extended to areas such as the foot, where their uses have been reported on fewer occasions, with equally good results.