Authors of section

Authors

Andrew Howard, James Hunter, Theddy Slongo

Executive Editor

Fergal Monsell

General Editor

Chris Colton

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Capsular decompression

1. Preliminary remarks

Introduction

One potential cause of avascular necrosis (AVN) is high intraarticular pressure due to hematoma formation causing intracapsular tamponade. Release of this hemarthrosis may reduce the risk of developing avascular necrosis.

In cases where fixation has been performed without exposure of the fracture, a limited anterior approach is the most direct way to visualize and safely decompress the capsular cavity.

2. Release of joint tamponade

Incision

A 2.5 cm incision is made below the anterior superior iliac spine (ASIS) and parallel with the iliac crest. This incision can often be placed in a skin crease for good cosmesis.

capsular decompression

Dissection

The incision is deepened to fascia and the interval between the sartorius and the tensor fascia lata is palpated. This interval is easier to identify distally in the wound and becomes confluent as the insertions into the ASIS are approached.

capsular decompression

The fascia over the interval is incised with a scalpel and the plane developed with blunt scissors.

capsular decompression

The lateral femoral cutaneous nerve may be identified and retracted medially with the sartorius muscle.

Directly deep to these muscles, the rectus femoris tendon is readily identified. It is round, shiny, and silvery. It can be mobilized and retracted medially exposing the capsule over the femoral neck.

capsular decompression

The joint capsule is incised, releasing the tense hemarthrosis.

capsular decompression

Closure

The joint capsule is left open. The muscle planes do not need suturing. The subcutaneous tissue and skin can be closed with absorbable sutures.

capsular decompression