| Introduction |
- Indications
- ORIF of intertrochanteric, peritrochanteric hip, femoral neck fractures
- open treatment of SCFE
- subtrochanteric, intertrochanteric osteotomy
- ORIF of femoral shaft and supracondylar femur fractures
- extraarticular arthrodesis of the hip joint
- treatment of chronic osteomyelitis
- biopsy and treatment of bone tumors
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| Intramuscular plane |
- No internervous or intermuscular plane
- Intramuscular plane
- split the tensor fascia lata (superior gluteal nerve)
- split vastus lateralis (femoral nerve)
- Blood Supply of thigh
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| Preparation |
- Anesthesia
- general
- spinal, epidural, and/or femoral blocks
- Position
- supine
- with sandbag below buttock to internally rotate operative leg
- lateral decubitus
- Tourniquet
- can be applied for distal femur surgery
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| Approach |
- Incision
- landmark
- palpate tip of greater trochanter
- make incision longitudinal
- beginning over the midline of greater trochanter
- extending down the lateral side of the thigh in line with the lateral aspect of the femur
- Superficial dissection
- incise tensor fascia lata
- Deep dissection
- incise the fascia over the vastus lateralis
- split vastus lateralis
- can also lift vastus lateralis off intermuscular septum
- watch for perforators
- can retract into the posterior compartment of the thigh
- expose desired area of femur with subperiosteal dissection continued distally as necessary
- helpful to place homan retractors over anterior and posterior aspects of femur
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| Dangers |
- Perforating branches of the profunda femoris artery
- at risk within vastus lateralis dissection
- should be ligated to prevent hematoma
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