Harry Morris1 , Manoj M. K.2
BACKGROUND Calcaneum fractures are the most common type of fractures affecting tarsal bone. It accounts for about 60% of all tarsal bone fractures and 2% of adult fractures. 75% of the calcaneal fractures are intra-articular and usually associated with poor outcome. Most common cause of this type of fracture being axial loading i.e., fall from height injuries or in road traffic accidents. The study was done to evaluate the functional and radiological outcome of intra-articular calcaneal fractures treated with Essex-Lopresti technique, as measured by the AOFAS Scoring system, the mean duration of radiological union and the radiological outcome using preand post-operative Bohler's angle and associated complications. METHODS From 1st Jan 2017 to 1st June 2018, 36 patients with intra articular calcaneal fractures presented to casualty of which 28 patients were tongue type according to Essex-Lopresti classification and were treated with Essex-Lopresti technique using 4.5 mm Steinman pin. Patients were followed up regularly at 6 weeks, 12 weeks and 6 months. The time taken for radiological union was noted. After satisfactory radiological union, the functional outcome and radiological outcome was studied by the ‘American Orthopaedic Foot and Ankle Society (AOFAS)’ ankle hind foot scoring system and using pre- and post-operative Bohler's angle measurements. RESULTS The average age of patients in our study was 39.14 years of which all except two were female. Fall from height was the mode of injury in majority of patients except for three which were road traffic accidents. The right calcaneum was involved more commonly than the left. Fracture classification was based on the Sanders and Essex-Lopresti methods. For the study purpose Essex-Lopresti classification was used and all were tongue type fractures according to Essex-Lopresti classification. The functional and radiological outcome was better in tongue type fractures treated with Essex-Lopresti technique. All the patients had signs of radiological union on second follow up at 12 weeks. The average time for union in all the 28 patients was 12.86 weeks. The functional outcome was excellent in 16 patients, good in 8 patients and fair in 4 cases. CONCLUSIONS We are of the opinion that when surgery is opted as a choice of treatment in calcaneal fracture with tongue type variety, Essex-Lopresti technique is good in terms of union of functional outcome in relation to function and range of movements and radiological outcome in relation to pre- and post-op Bohler’s angle.
