Authors of section

Authors

Florian Gebhard, Phil Kregor, Chris Oliver

Executive Editor

Chris Colton, Richard Buckley

Open all credits

Posterior approach to the distal femur

1. Principles

Use of the posterior approach: mainly in coronal plane (Hoffa) fractures of the condyle

The posterior approach is mainly used for fractures of the condyles in the coronal plane (Hoffa) in cases of an extremely posterior fracture line. It may also be used in neurovascular repair and posterior cruciate avulsion injuries.

posterior approach to the distal femur

Neurovascular structures

The neurovascular structures of the knee joint are at risk during the posterior approach. They are located between the two femoral condyles and the heads of the gastrocnemius muscle.

The location of the anatomical bifurcation of the tibial nerve varies and therefore careful dissection is essential. The use of a tourniquet facilitates the identification of the neurovascular bundle.

Neurovascular structures.

2. Skin incision

Make an S-shaped skin incision over the popliteal fossa with the oblique section of the incision lying in the area of the joint line.

The approach can be extended proximally according to the dashed line.

Make an S-shaped skin incision over the popliteal fossa.

3. Open the deep fascia

Open the deep fascia of the leg in the posterior midline. Crossing veins have to be ligated.

Open the deep fascia of the leg in the posterior midline. Crossing veins have to be ligated.

4. Neurovascular structures

Identify and retract the neurovascular structures carefully.

It is essential to ligate the veins in the posterior approach, rather than using cautery.

Identify and retract the neurovascular structures carefully.

5. Expose fracture fragment

Identify the posterior capsule of the knee.

Expose the posterior condyle on the fractured side.

Where both condyles are fractured only one condyle is exposed at a time.

Identify the posterior capsule of the knee.

6. Wound closure

After relaxing the tourniquet, ensure good hemostasis. The use of a suction drain can be considered. Close the deep fascia of the leg, followed by skin sutures.