History reveals an axial load mechanism, with the worst fractures resulting from falls from a height or motor vehicle collisions. Low impact injuries may have a small rotational component of force that was applied to the ankle, but will still have an axial component to the mechanism.

     The skin must be carefully examined because many of these fractures are open. Soft tissue swelling may occur rapidly and be severe.  A complete neurovascular exam should be performed since compartment syndrome can be a limb-threatening complication of this injury.

     High impact mechanisms warrant a complete exam to look for associated injuries. Vertebral compression fractures, especially L1, may occur with extreme axial loading. Vertical shear injuries can occur, especially in the contralateral calcaneus, tibial plateau, pelvis, and acetabulum.