Outcome evaluation of minimally invasive surgery versus extensile lateral approach in management of displaced intra-articular calcaneal fractures: A randomised control trial. (June 2017)

• Record Type: Journal Article
• Authors: Khurana, Ankit; Dhillon, Mandeep S.; Prabhakar, Sharad; John, Rakesh
• Is Part Of: Foot. Volume 31(2017)
• Page Start: 23
• Page End: 30
• Publication Date: 2017-06
• Subjects: Displaced intra-articular calcaneal fractures (DIACFs) -- Calcaneum fracture -- American Orthopaedic Foot and Ankle Score (AOFAS) -- Minimally invasive surgery (MIS) -- Extensile lateral approach; Foot -- Diseases -- Periodicals; Foot -- Surgery -- Periodicals; Foot Diseases -- Periodicals; Foot -- surgery -- Periodicals; Pied -- Maladies -- Périodiques; Pied -- Chirurgie -- Périodiques; Pied -- Lésions et blessures -- Périodiques; Foot -- Diseases; Foot -- Surgery; Periodicals; Electronic journals; Electronic journals; 617.585005
• DOI: 10.1016/j.foot.2017.01.008
• Languages: English
• ISSNs: 0958-2592

Abstract

Highlights: Minimally invasive surgery has a significant and evolving role in the treatment of closed DIACFs. MIS methods minimize soft tissue complications compared to ORIF. There are several MIS techniques described each with a unique set of indications and complications. However, ORIF with extensile lateral approach, in a tertiary care hospital with experienced surgeons, has better clinical outcomes compared to MIS techniques. Abstract: Background: Minimally invasive surgery has a significant and evolving role in the treatment of DIACFs, but there is limited literature on this topic. Objectives: To compare the clinico-radiological outcomes of DIACFs fixed with MIS technique with ORIF. Methods: This randomised control trial (RCT) included 21 closed Sanders type 2 and 3 DIACFs which were selected from 70 who presented. Extensile lateral approach was used in the ORIF group; while MIS techniques included either percutaneous reduction or small incisions with indirect fragment manipulation. Main Outcome Measurement: AOFAS hindfoot score, pre-operative and postoperative radiology. Results: There were 9 fractures in the Extensile group and 12 in the MIS group, with both groups having comparable demography, fracture classification, surgery delay & initial radiology. Bohler′s angle improved after surgery by an average of 18.44 with ORIF and 14.67 with MIS (p = 0.28). Mean AOFAS in the MIS group was 82.58 (66.67% good and 33.33% fair) and was 89.56 (44.44% excellent, 55.56% good, 0 fair/poor) with ORIF (p = 0.034). Two patients who underwent ORIF had a major complication (one deep infection and Sural nerve injury each) while none in the MIS group. Conclusions: MIS methods minimized soft tissue complications and achieved comparable radiological reductions but clinical outcomes were poorer, with percutaneous methods having the worst outcomes.