Posterolateral Approach to Femur
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The posterolateral approach to femur can expose the entire length of the femur.
- The uses of the posterolateral approach to femur include the following:
- Helpful for exposure of entire length of femur.
- Open reduction internal fixation of femur fractures especially supracondylar femoral fractures.
- Open reduction for intramedullary nail passage for femoral shaft fractures.
- Treatment of femoral nonunions.
- Femoral osteotomies.
- Treatment of chronic or acute osteomyelitis.
- 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:
- 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.
- Perforating branches of profunda femoris artery:
- Surgical Exposures in Orthopaedics book - 4th Edition
Orthopedic Approaches App
