title: Ligamentotaxis for complex calcaneal fractures using Joshi's external stabilization system.
abstract: BACKGROUND
  Controversies exist in the literature regarding the management of complex fractures of the calcaneum. We evaluated a series of complex fractures of the calcaneum managed by ligamentotaxis using Joshi's external stabilization system (JESS) for its efficacy.
  
  
  METHODS
  Forty-five patients having complex (comminuted, intra-articular fracture with compromised soft tissue condition) fractures of the calcaneum, who were treated by external fixator (JESS) based on the principle of ligamentotaxis. The gradual distraction was done to bring the articular margins together to maintain both alpha and beta angles to near normal range. Thirteen (28.9%) patients underwent additional corticocancellous bone grafting with elevation of posterior facet. All patients were evaluated for their functional outcomes by American Orthopedic Foot and Ankle society (AOFAS) Score for the ankle and hind foot. Mean duration of follow-up was 20.5 months.
  
  
  RESULTS
  Forty-two (93.4%) of our patients did well with the ligamentotaxis. On evaluating final outcomes by AOFAS, approximately 71% of cases showed good results. Eleven patients (24.4%) complained of persistent heel pain in the long-term follow-up. Out of these, eight (17.8%) patients were those who had severe comminution with almost total loss of calcaneal height. The origin of heel pain was not the subtalar joint in all of these patients. On long-term follow-up none of these patients suffered from such severe pain so as to compel them to change the nature of their activity.
  
  
  CONCLUSIONS
  We conclude that ligamentotaxis by JESS provides a viable and user-friendly alternative method of management of these complex calcaneal fractures.
authors.affiliation: Department of Orthopedics, CSM Medical University, Lucknow, UP, India. as29762@gmail.com
authors.forename: Ajai
authors.initials: A
authors.lastname: Singh
authors.forename: R N
authors.initials: RN
authors.lastname: Srivastava
authors.forename: M
authors.initials: M
authors.lastname: Jah
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar