Modified Essex-Lopresti / Westheus reduction for displaced intra-articular fractures of the calcaneus. Description of surgical technique and early outcomes.

We describe a modification of the classical Essex-Lopresti manoeuvre for the indirect reduction and stabilisation of displaced intra-articular fractures of the calcaneus. The radiological and functional results achieved using this technique in 15 patients is presented. Ten tongue-shaped and 8 joint depression type fractures were treated by the new method, incorporating the use of an additional traction pin. The pre and postoperative Böhler angles as well as the correction achieved were documented. Functional assessment was carried out using the Maryland Foot Score. The mean pre-operative Böhler angle in the joint depression group was 5.5 degrees, and in the tongue shaped fracture group 5 degrees. The mean postoperative Böhler angle in the joint depression group was 15.8 degrees, and in the tongue shape group was 23.25 degrees. At a mean follow-up of 28 months the joint depression group scored 51/100 on the foot score, and the tongue shaped fracture group 77/100. The mean correction achieved as well as the mean overall functional scores were significantly better in the tongue shaped group. The technique described has much promise in the management of selected displaced intra-articular fractures of the calcaneus (true tongue shaped / Sanders II), and may also have a limited role in other fracture types in patients with significant co-morbidities, soft tissue compromise and poor healing potential.