Lateral Approach




Split vastus lateralis




ORIF of femoral neck fractures 

Subtrochanteric or intertrochanteric osteotomy 

ORIF of femoral shaft or supracondylar femoral fractures 

Extra articular hip arthrodesis 

Treatment of chronic femoral osteomyelitis 

Biopsy and treatment of bone tumors 




Lateral position or fracture table 

- pad all prominences 


Longitudinal incision from middle of GT down lateral side of thigh 

- fasica lata split 

- may need to split TFL in line of fibres proximally to expose VL ( 30%)

- vastus lateralis split in line of fibres

- ligating perforators as located

- subperiosteal dissection of femoral shaft 


Posterolateral Approach




Elevate vastus lateralis anteriorly from lateral intermuscular septum




ORIF Supracondylar fracture 

Non unions of femoral fractures 

Femoral osteotomy 


Biopsy and treatment of bone tumors 





- use sandbag under buttock to expose posterolateral thigh 



- lateral epicondyle distally up posterolateral thigh proximally 


Internervous plane 

- between the vastus lateralis (covered by the ITB) and biceps femoris


Superficial dissection

- dissect the VL off the lateral intermuscular septum after posterior surface of ITB located

- difficult often as the VL has origin from the LIMS

- ligate the perforators 

- locate the linea aspera and take the periosteum off here 

- need retractor to elevate the vastus proximally due to bulk of muscle 


Extensile measures

- can extend into lateral parapatellar approach to knee

- allows visualisation of the knee joint for fracture reduction

- skin incision then curved anteriorly to Gerdy's tubercle 


Anteromedial Approach




Between Vastus Medialis and Rectus Femoris




ORIF of medial distal femoral fractures 

Treatment of osteomyelitis 

Biopsy of bone tumors 





- supine with leg draped free 



- 10-15 cm incision medial thigh between the rectus femoris and vastus medialis 

- extend distally as medial parapatellar incision if knee joint needs to be opened 


No internervous plane 


Superficial dissection 

- retract the RF laterally 

- begin distally and open the knee capsule in line with skin incision through the medial patellar retinaculum 

- split quads tendon with cuff of tendon on the VM allowing closure 

- expose the vastus intermedius proximally 

- split in line of fibres and subperiosteal dissection to expose femur 

- medial superior geniculate artery crosses field above the knee and should be controlled 

- must have good repair of the vastus medialis distally to avoid lateral patellar subluxation 


Extensile measures

- the incision can not be extended proximally as the vessels and nerve interfere 


Posterior Approach 




Between vastus lateralis and biceps femoris proximally

Access to middle 3/5 of femur and sciatic nerve




Infected non union of femur 

Chronic osteomyelitis 

Biopsy and treatment of bone tumors 

Exploration of sciatic nerve





- prone position with support and padding of pelvis and chest



- straight longitudinal incision down midline of posterior aspect of thigh

- ending proximally at inferior gluteal fold 


Internervous plane 

- between lateral intermuscular septum and biceps muscle 


Superficial dissection

- incise deep fascia in line of skin incision

- protect the posterior cutaneous nerve of thigh (in groove between semitendinosis and biceps)

- identify lateral margin of biceps proximally and develop plane between the biceps and VL

- retract long head biceps medially at proximal end and nerve retracted with it 


Deep Dissection

- detach short head of biceps from femur to expose shaft 

- distally long head of biceps retracted laterally and nerve exposed 

- sciatic nerve retracted laterally and posterior aspect of femur exposed 

- sciatic nerve not identified proximally but must be seen distally 

- cannot be extended proximally or distally