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OBJECTIVES: To evaluate the reduction and outcome of selected intraarticular calcaneal fractures treated with percutaneous Essex-Lopresti reduction and fixation. DESIGN: Prospective consecutive series. SETTING: Level one trauma center and tertiary university hospital. PATIENTS/PARTICIPANTS: Twenty-six consecutive patients with an Essex-Lopresti tongue-type, Sanders type 2C calcaneus fracture. INTERVENTION: Modified percutaneous Essex-Lopresti type spike reduction and fixation of the posterior facet. OUTCOME MEASUREMENTS: Clinical and radiographic analysis. METHODS: Twenty-six consecutive patients with calcaneal fractures meeting the criteria had an attempted percutaneous reduction performed under fluoroscopic control with the patient in the lateral position. Twenty-three of the twenty-six feet had an acceptable reduction, and the remaining three were treated with open reduction and internal fixation (ORIF). The first seventeen cases were stabilized by two Steinmann pins, which were removed at ten to twelve weeks. The last six cases were fixed with two cannulated 6.5-millimeter screws, which were left in place. Early motion was encouraged in all cases RESULTS: Of the twenty-three patients with an acceptable reduction, twenty had no angulation between the posterior facet of the talus and the calcaneus and three had <5 degrees. The tuberosity reduction was <5 degrees in seventeen cases and <10 degrees in all cases. The calcaneal height was restored to normal in twenty cases, and the width (axial view) averaged 119 percent of the contralateral side. Follow-up averaged 2.9 years. Using the Maryland foot score there were twelve (55 percent) excellent, seven (32 percent) good, and three (13 percent) fair results. CONCLUSIONS: The Essex-Lopresti spike reduction is a useful method for the treatment of tongue-type Sanders type 2C fractures of the calcaneus. Results are superior to those in previous series of intraarticular fractures treated with ORIF.