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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
 
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 

Preparation
  • Anesthesia
    • general
    • spinal, epidural, and/or femoral blocks
  • Position
    • supine
      • with sandbag below buttock to internally rotate operative leg
    • lateral decubitus
      • best for shaft of femur
  • Tourniquet
    • can be applied for distal femur surgery

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

 

 

Dangers
  • Perforating branches of the profunda femoris artery
    • at risk within vastus lateralis dissection
    • should be ligated to prevent hematoma
 

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