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:
- Treatment of infected cases of nonunion.
- Treatment of chronic osteomyelitis.
- Biopsy and treatment of bone tumors.
- 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:
- Posterior femoral cutaneous nerve.
- Sciatic nerve.
- Nerve to biceps femoris.
- Surgical Exposures in Orthopaedics book - 4th Edition
- Campbel's Operative Orthopaedics book 12th