Minimally Invasive Neuropathic Reconstruction (MiNR study)

Abstract

Category: Diabetes; Ankle; Hindfoot; Midfoot/Forefoot; Trauma; Other Introduction/Purpose: Charcot neuroarthropathy (CN) is caused by peripheral neuropathy leading to undetected injuries of the bones, joints, and soft tissues [1]. Currently, the surgical management of CN is guided by small retrospective case series and expert opinions [2, 3, 5, 7, 32]. Traditional reconstructive surgical approaches involve large, open incisions to remove bone, as well as the use of internal and external fixation in an attempt to fuse dislocated joints. Theoretically 1ninimally invasive surgery takes the tension off the soft tissues which ensures that there is still good tissue cover without compromising the blood supply to the skin and reduces risk of infection [25]. Also, minimally invasive techniques are associated with fewer wound complications and fewer nerve complications when compared to open classical approaches [9, 10]. The purpose of our retrospective study is to determine if open versus minimally invasive Charcot foot reconstruction fusion rates and complication rates are equivalent or better in the minimally invasive group. Methods: We define minimally invasive surgery as any percutaneous technique, simple exostectomy, arthrodesis, and reconstruction with relatively small surgical incisions. Results: The study analyzed the pre and post operative course of 44 patients. The study included 25 male and 19 female participants between the ages of 41 - 89 and a mean participant age of 67.5. We looked at patients who underwent treatment for Charcot's foot and found that 68% of these patient had diabetes mellitus. Of the surgical patients 32% were minimally invasive, 55% open and I 3% both minimally invasive and open combination. Conclusion: At 6 months there was no significant difference in the fusion rates or complications across the open, MIS and combination groups. Further study is warranted to determine the optimal candidate and scenario for such technique.