Posterolateral Approach to Femur

  • The posterolateral approach to femur can expose the entire length of the femur.

  • The uses of the posterolateral approach to femur include the following:
    1. Helpful for exposure of entire length of femur.
    2. Open reduction internal fixation of femur fractures especially supracondylar femoral fractures.
    3. Open reduction for intramedullary nail  passage for femoral shaft fractures.
    4. Treatment of femoral nonunions.
    5. Femoral osteotomies.
    6. Treatment of chronic or acute osteomyelitis.
    7. Biopsy and treatment of bone tumors.

  • Supine Position:
    • Place the patient supine on the operating table with a sandbag beneath the buttock on the affected side to elevate the buttock and rotate the leg internally, bringing the posterolateral surface of the thigh clear of the table.
  • Lateral decubitus Position.

  • Landmarks:
    1.  Lateral femoral epicondyle.
  • Incision:
    • Make incision longitudinal on the posterolateral aspect of the thigh.
    • Continue proximally along the posterior part of the femoral  shaft.

  • The internervous plane for the posterolateral approach to femur lies between:
    • The vastus lateralis muscle which is supplied by the femoral nerve).
    • The lateral intermuscular septum, which covers the hamstring muscles  which are supplied by the sciatic nerve.

  • Through tensor fascia lata in line with its fibers and the skin incision.

  • Reflect vastus lateralis muscle anteriorly and dissect between it and lateral intermuscular septum (it’s easier to identify plan distally).
  • Can continue vastus lateralis elevation until linea aspera is seen.
  • Incise the periosteum and continue dissection on top of femur:
    • Helpful to place homan retractors over anterior and posterior aspects of femur.

  • Proximal Extension:
    • The posterolateral approach to femur can be extended superiorly to the greater trochanter, to expose virtually the entire femoral shaft.
    • Note that, superiorly, the tendon of the gluteus maximus muscle lies behind the lateral intermuscular septum.
  • Distal Extension:
    • The approach can be extended distally into a lateral parapatellar approach to the knee joint.
    • This allows accurate visualization of the entire distal end of the femur.
    • This extension is used to allow reduction and fixation of intraarticular fractures of the distal femur.

  • The structures at risk during the posterolateral approach to femur include:
    • Perforating branches of profunda femoris artery:
      • At risk as they pierce lateral intermuscular septum.
      • Should be ligated to prevent hematoma.
    • Superior lateral geniculate vessels:
      • At risk distally near femoral condyles.
      • Should be ligated to prevent hematoma.

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