Lateral Approach to Femur

  • Lateral Approach to femur is an extremely quick and easy approach, it involves splitting the vastus lateralis muscle.

  • The subsequent blood loss that results from the rupture of vessels during this procedure may make surgery awkward, but rarely is life-threatening.
  • Lateral Approach to femur is used for:
    1. Open reduction internal fixation of intertrochanteric, peri-trochanteric hip, femoral neck fractures.
    2. Open treatment of slipped capital femoral epiphysis.
    3. Sub-trochanteric, intertrochanteric osteotomy.
    4. Open reduction internal fixation of femoral shaft and supracondylar femur fractures.
    5. Extraarticular arthrodesis of the hip joint.
    6. Treatment of chronic osteomyelitis.
    7. Biopsy and treatment of bone tumors.

  • Supine position:
    • With sandbag below buttock to internally rotate operative leg.
  • Supine position on  an orthopedic table:
    • For trochanteric fractures.
    • Use an orthopedic table for any procedure that involves the use of an image intensifier.
  • Lateral decubitus:
    • Best for surgery on the shaft of the femur.

  • Landmarks:
    1. Greater trochanter.
    2. Shaft of the femur.
  • Incision:
    • Make a longitudinal incision:
      • beginning over the midline of greater trochanter.
      • extending down the lateral side of the thigh in line with the lateral aspect of the femur.

  • There is No internervous for lateral approach to femur.
  • Intramuscular plane:
    • Split the tensor fascia lata which innervated by superior gluteal nerve.
    • Split vastus lateralis which innervated by femoral nerve.

  • Incise tensor fascia lata in line with skin incision.

  • Incise the fascia over the vastus lateralis muscle.
  • Split vastus lateralis muscle:
    • Can also lift vastus lateralis off intermuscular septum.
      • watch for perforators:
        • can retract into the posterior compartment of the thigh.
  • Expose desired area of femur with sub-periosteal dissection continued distally as necessary:
    • Helpful to place homan retractors over anterior and posterior aspects of femur.

  • The lateral approach to femur is most useful for exposing the proximal third of the bone for internal fixation of a hip fracture.
  • It can be extended to the knee joint to allow full exposure of the lateral aspect of the femoral shaft for reduction and fixation of all
    types of femoral fractures.

  • The structures at risk during the lateral approach to femur includes:
    • Perforating branches of the profunda femoris artery:
      • At risk within vastus lateralis dissection.
      • Should be ligated to prevent hematoma.

  • Surgical Exposures in Orthopaedics book - 4th Edition
lateral approach to femur lateral approach to femur lateral approach to femur lateral approach to femur lateral approach to femur lateral approach to femur lateral approach to femur
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