Modified Technique of Essex-Lopresti Axial Fixation for Calcaneal Fracture

Junng, Woo Koo; Kim, Byung Seol; Na, Kee Joon

Abstract

In Essex-Lopresti conventional method, a heavy Steinmann pin is introduced into the cancellous part of tongue fragment and with knee flexed,the fracture is reduced by lifting upward on the pin. However it is hard to restore the anatomical position in the body of calcaneus because the tip of pin, positioned on cancellous part of tongue fragment, could not make adequate force on distal fragment especially in the case of osteoporosis or aged patients. Authors made one modification that the tip of pin was introduced from the upper tuberosity through the fracture site into the plantar cortical surface of posterior fragment and the fragment was lifted superiorly It was easy to reduce fracture by the lever arm effect, which made counter forces on anterior and posterior fragments against mechanism of fracture simultaneously. The authors had treated the 35 cases of 31 patients with displaced intra-articular calcaneal fractures using the modified techique of Essex-Lopresti axial fixation at Seoul Eul-Ji General Hospital from April 1989 to January 1993 and analyzed 31 cases of 21 patients after the follow-up from 12 months to 38 months (mean 16.5 months). The results were as follows; 1. Among 31 cases, 22 were tongue type and 9 were comminuted fracture with the joint depression. 2. Bohlers angle was changed from -5.4 in average preoperatively to 30.5 in average postoperatively. 3. according to Rowe evaluations, the clinical results were evaluated as excellent in 9, good in 13, fair in 7, poor in 2 cases. 4. Two poor cases were the joint depression type, which showed decreased Biihlers angle during follow up period. 5. In 7 cases, traumatic arthritis was developed on subtalar joint radiologically but there was no clinical need of subtalar fusion clinically 6. One case required the excision of traumatic bony spur. 7. There was no operative infection.