Updated: 2/14/2018

Femur Posterolateral Approach

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Introduction
  • Indications
    • helpful for exposure of entire length of femur
    • ORIF
      • especially supracondylar femur fractures
    • open reduction for IMN passage for femoral shaft fractures
    • treatment of femoral nonunions
    • femoral osteotomies
    • treatment of chronic or acute osteomyelitis
    • biopsy and treatment of bone tumors
Internervous plane
  • Between
    • vastus lateralis  (femoral nerve)
    • lateral intermuscular septum covering the hamstring muscles  (sciatic nerve) 
Preparation
  • Anesthesia
    • general
    • spinal, epidural, and/or femoral blocks
  • Position
    • supine
      • with sandbag below buttock
    • lateral decubitus
  • Tourniquet
    • can be applied for distal femur surgery
Approach
  • Incision
    • landmarks
      • palpate lateral femoral epicondyle for distal landmark
    • make incision longitudinal on the posterolateral aspect of the thigh
    • continue proximally along the posterior part of the shaft
  • Superficial dissection
    • through tensor fascia lata
  • Deep dissection
    • reflect vastus lateralis anteriorly and dissect between it and lateral intermuscular septum
      • 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 
Dangers
  • 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
 

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