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  • Title: Outcome evaluation of minimally invasive surgery versus extensile lateral approach in management of displaced intra-articular calcaneal fractures: A randomised control trial.
    Author: Khurana A, Dhillon MS, Prabhakar S, John R.
    Journal: Foot (Edinb); 2017 Jun; 31():23-30. PubMed ID: 28324822.
    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.
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