Functional Outcomes of Displaced Intra-Articular Calcaneal Fractures: A Randomized Superiority Trial of Essex-Lopresti Versus 3-Point Distraction Technique by Forgon and Zadravecz

IntroductionOpen reduction and internal fixation with plating is the most common surgical method of treatment for displaced intra-articular calcaneal fractures, but it has a high infection rate, which leads to chronic osteomyelitis, causing permanent disability; also, the postoperative complications are higher than those of percutaneous techniques. Thus, percutaneous fixation techniques using various indirect reduction methods provide an alternative to addressing these issues. Our study aimed to compare the functional outcomes of displaced intra-articular calcaneal fractures treated with percutaneous fixation using the Essex-Lopresti technique and 3-point distraction technique described by Forgon and Zadravecz.Materials and methodsA prospective randomized superiority study of displaced intra-articular calcaneal fractures was conducted between July 2015 and June 2020. Patients were randomized into 2 groups; group A was operated using the Essex-Lopresti technique, and in group B, a 3-point distracter was used to aid reduction. Functional assessment was done using calcaneal fracture scoring system of Kerr et al and Maryland foot scoring system.ResultsThere were 43 patients with 46 displaced intra-articular calcaneal fractures, with 27 males and 11 females. The mean duration of follow-up was 28 months. There were 20 patients with 23 calcaneal fractures in group A and 18 patients with 18 calcaneal fractures in group B. No statistically significant difference was found in functional outcomes of both techniques, but the operating time was significantly longer in group B patients.ConclusionBoth the Essex-Lopresti technique and use of a 3-point distractor coupled with percutaneous cancellous screw fixation of displaced intra-articular calcaneal fractures provide good functional outcomes with minimal complications. There is no statistically significant difference in the functional outcomes, but outcome scores were better in the 3-point distractor group.