https://upload.orthobullets.com/topic/12026/images/preop femur ap.jpg
https://upload.orthobullets.com/topic/12026/images/intraop femur final ap.jpg
  • Indications
    • Open reduction and internal fixation (ORIF) of distal femur fractures 
      • particularly fractures with intra-articular extension that require a medial plate  
    • ORIF of femoral shaft fractures
      • limited to distal 2/3 of femur by the presence of the femoral neurovascular bundle
    • Treatment of chronic osteomyelitis
    • Biopsy and treatment of bone tumors of the femur
    • Quadricepsplasty

  • Internervous
    • no true internervous plane
  • Intermuscular
    • intermuscular plane between
      • rectus femoris (femoral nerve)  AND
      • vastus medialis (femoral nerve)  q
        • innervation is proximal allowing for safe exposure distally
  • Anesthesia
    • as dictated by the type of procedure 
    • most cases involving the anteromedial approach will require a general anesthetic
  • Position
    • supine on radiolucent table for fracture fixation
    • prepare and drape the affected extremity so that it can be moved freely
    • consider bump under contralateral hip to facilitate access to the medial femur
  • Tourniquet
    • elevate if needed for visualization
    • use sterile tourniquet so as not to limit proximal extension of draping or exposure
  • Incision
    • 10- to 15-cm longitudinal incision 
      • centered over the interval between rectus femoris and vastus medialis
      • vastus may be atrophied in patients with knee pathology making identification difficult
      • extend distally along medial aspect of patella if exposure of the knee joint is required
  • Superficial dissection
    • incise deep fascia
      • incise in line with skin incision
  • Deep dissection
    • open knee joint capsule
      • begin distally by opening the knee joint capsule via the medial retinaculum
    • split the quadriceps tendon proximally
      • leave a cuff of tendon attached to the vastus to allow for later repair
    • develop the interval between vastus medialis and rectus femoris
    • identify and split vastus intermedius proximally
      • split vastus intermedius in line to expose femur
    • incise the periosteum longitudinally and elevate as needed for exposure

  • Medial superior genicular artery
    • crosses field just above knee joint
  • Vastus medialis
    • distal fibers insert directly on medial border of patella
    • disrupted during exposure
    • meticulous closure to prevent lateral patella subluxation

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Questions (1)

(OBQ04.31) Hunter's Canal is bordered by what two muscular compartments? Review Topic

QID: 92

Anterior and lateral compartments of the leg




Lateral and posterior compartments of the leg




Anterior and medial compartments of the thigh




Medial and posterior compartments of the thigh




Anterior and posterior compartments of the forearm



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