A 45-year-old man falls from height and sustains a calcaneal fracture. Lateral radiograph shows a large posterolateral fragment containing the posterior facet hinged superiorly like a trap door, threatening the overlying skin. According to the Essex-Lopresti classification this is a tongue-type fracture, and its immediate significance is:
- A It mandates primary ankle arthrodesis
- B The prominent fragment stretches the thin posterior soft tissue envelope, risking full thickness skin necrosis, so urgent percutaneous reduction is advised before skin compromise ✓
- C It is managed definitively in a below-knee cast without surgery
- D It always requires emergent open reduction through a extensile lateral approach within 6 hours
Correct answer: B. The prominent fragment stretches the thin posterior soft tissue envelope, risking full thickness skin necrosis, so urgent percutaneous reduction is advised before skin compromise
Explanation
Essex-Lopresti divided displaced intra-articular calcaneal fractures into joint depression and tongue types. The tongue-type pattern drives the sharp superiorly rotated fragment against the fragile posterior heel skin, and pressure necrosis can convert it into an unsalvageable open problem within hours. Prompt closed or percutaneous levering and pinning protects the soft tissues; an extensile approach is avoided until swelling settles.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.