Evaluation of percutaneous fixation of intra articular fractures of calcaneum using Essex Lopresti manoeuvre

Abstract

Background: Debate continues regarding the ideal management of calcaneal fractures, between open reduction and internal fixation and closed methods. Open plating has failed to prove its superiority over closed methods owing to poor soft tissue coverage, severe soft tissue swelling, lack of availability of sturdy implants and complications associated with plating. Hence we evaluated the outcome of percutaneous fixation of tongue type intra-articular fracture of calcaneum by Essex Loprestimanoeuvre.

Material and methods: 30 tongue type intra-articular fractures of calcaneum in 23 patients operated by Essex Loprestimanoeuvre by closed reduction and percutaneous pin fixation were assessed functionally by Maryland foot score and radiologically by Bohler’s angle and Gissane’s angle.

Results: 30 calcaneal fractures with mean age 31.6 years and mean follow up of 8.3 months were included in the study. The mean pre-operative Bohler’s angle improved from 8.300 ± 3.84, to 24.470 ± 8.31 immediate postoperatively and to 24.330 ± 8.46 at final follow up of 6 months, respectively. The mean pre-operative Gissane’s angle improved from 134.130 ± 7.03, to 123.150 ± 8.79 immediate postoperatively and to 123.550 ± 8.82 at final follow up of 6 months, respectively. Mean union time was 9 weeks. The mean Maryland Foot Score was 83.43 ± 7.53 (range 61 to 92) and 86 % cases had excellent to good results.

Conclusion: Essex-Lopresti’s method for treatment of tongue-type fractures of calcaneum is easy, cost effective, day care procedure provides stable fixation, early mobilization and excellent results, with low complication rates.