Posterior Approach to Femur

  • The posterior approach to femur involves dissection of the posterior compartment of the thigh.

  • The key to the approach lies in understanding the anatomy of the sciatic nerve and its relationship to the biceps femoris muscle.

  • The posterior approach to femur uses include:
    1. Treatment of infected cases of nonunion.
    2. Treatment of chronic osteomyelitis.
    3. Biopsy and treatment of bone tumors.
    4. Exploration of the sciatic nerve.

  • Prone position.

  • Make a Longitudinal incision (20 cm) down the midline of the posterior aspect of the thigh.

  • Internervous plane for the posterior approach to femur lies between:
    • Lateral intermuscular septum which covers vastus lateralis muscle innervated by the femoral nerve.
    • Biceps femoris muscle which is innervated by sciatic nerve.

  • Deep fascia of the thigh.
  • Avoid posterior femoral cutaneous nerve.

  • Begin proximally; retract the long head of biceps femoris medially and lateral intermuscular septum laterally.
  • In the distal half, retract the long head of the biceps laterally to expose the sciatic nerve; retract the sciatic nerve laterally.
  • excise periosteum longitudinally.
  • expose desired area of femur with subperiosteal dissection.

  • The structures at risk during the posterior approach to femur includes:
    1. Posterior femoral cutaneous nerve.
    2. Sciatic nerve.
    3. Nerve to biceps femoris.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
posterior approach to femur
Images Source:
  • Surgical Exposures in Orthopaedics 4th Edition Book.

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