The open approach to the lateral surface of the femur is used for techniques requiring exposure of the femoral shaft and direct reduction. It can also be used for an "Open-but-do-not-touch" approach. This allows visualization of the fracture and indirect reduction, without removal of the fracture hematoma and without performing manipulation of the fragments.
2. Skin incision
The skin incision is made along the craniolateral border of the femoral shaft from the level of the greater trochanter to the level of the patella. The subcutaneous fat and superficial fascia are incised or bluntly dissected directly under the skin incision.
The superficial fascia is retracted. The junction between the fascia lata and the biceps muscle is carefully identified by looking at the direction of the fibers.
The fascia lata is incised along the cranial border of the biceps femoris. This incision extends the entire length of the skin incision. If muscle fibers are encountered, the incision should be directed more cranially.
Caudal retraction of the biceps femoris reveals the shaft of the femur. It is necessary to incise the fascial aponeurotic septum between the vastus muscle and the biceps muscle on the lateral shaft of the femur to adequately expose the bone.
The vastus lateralis and intermedius muscles, on the cranial surface of the femoral shaft, are retracted cranially by freeing the loose fascia between the muscle and the bone. Take care to avoid unnecessary detachment of the adductor magnus muscle as it attaches on the fascies aspera of the femur and is the major blood supply to the fractured bone.
If it is necessary to expose the greater trochanter for implant placement, the attachment of the vastus lateralis on the neck of the femur may be partially incised.