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