Ankit Khurana1, Mandeep S Dhillon2, Sharad Prabhakar3, Rakesh John4. 1. UCMS and GTB Hospital, India. Electronic address: ankit24388@gmail.com. 2. Department of Orthopaedics, PGIMER, Chandigarh, India. Electronic address: drdhillon@gmail.com. 3. Department of Orthopaedics, PGIMER, Chandigarh, India. Electronic address: sharad.ortho@gmail.com. 4. PGIMER, Chandigarh, India. Electronic address: rakeshjohn23@gmail.com.
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.
RCT Entities:
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.