Open hindfoot injuries.

Successful management of open talar and calcaneal injuries of the hindfoot is a formidable orthopaedic challenge. The soft-tissue disruption associated with these high-energy traumatic injuries adds to treatment complexity. Extensive fracture comminution and cartilage damage are often present with calcaneal fracture. Osteonecrosis is commonly associated with talar injury. Treatment may be divided into acute and reconstructive phases. Successful outcome is dependent on several variables--accurate fracture reduction, timing of intervention, prevention of infection, and meticulous soft-tissue handling. Anatomic fracture or joint reconstruction may not be possible. Joint stiffness and posttraumatic arthritis are common and may be debilitating. Complications, such as infection and osteonecrosis, also can be devastating. Long-term outcomes are frequently unsatisfactory. Chronic ambulatory dysfunction and persistent neurogenic pain may result despite appropriate management. With severe complex open fractures and extended soft-tissue injury, limb amputation may be the best treatment option.