Authors of section

Authors

Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken

Executive Editors

Joseph Schatzker, Peter Trafton

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Iliofemoral approach to the hip joint (for ORIF of femoral neck and head fractures)

1. Preliminary remarks

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.

The skin incision begins over the lateral iliac crest and follows it to the anterior superior iliac spine.

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.

Release the abductor muscles from the lateral iliac crest and deepen the incision anteriorly, along the lateral border of ...

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.

Identify, divide and ligate the lateral femoral circumflex vessels distally. Release the direct head of rectus femoris ...

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.

A T-shaped incision, with retention sutures medially and laterally, allows exposure of the femoral head and neck.