The anterior approach (iliofemoral or Smith-Peterson) provides the most direct access to the anterior aspect of the hip. Many surgeons believe that this is preferable for reduction of femoral head and neck fractures.
Note Fixation of femoral neck fractures reduced through this approach will require separate percutaneous screw placement, or a separate lateral incision for a sliding hip screw.
2. Skin incision
The skin incision begins over the lateral iliac crest and follows it to the anterior superior iliac spine. There it turns distally to follow the lateral side of the sartorius muscle.
3. Develop interval between tensor fascia lata and sartorius
Release the abductor muscles from the lateral iliac crest and deepen the incision anteriorly, along the lateral border of sartorius. Separate bluntly the tensor fasciae latae from the sartorius.
4. Deep surgical dissection
Identify, divide and ligate the lateral femoral circumflex vessels distally. Release the direct head of rectus femoris from the anterior inferior iliac spine, either through the tendon, or with an osteotomy. Release the reflected head of this muscle from its more lateral attachment proximal to the hip capsule.
A T-shaped incision, with retention sutures medially and laterally, allows exposure of the femoral head and neck. Protect the labrum during the capsulotomy. Lateral traction and repositioning the leg improves access to the bony pathology. With this exposure, many femoral head and neck fractures can be fixed without dislocation of the hip.