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Lateral/anterolateral approach

Principles

General considerations

The lateral approach to the distal femur allows for visualization, reduction and fixation of simple articular fractures of the distal femur. More complex fractures (particularly those involving the medial femoral condyle) are better exposed with a lateral parapatellar approach.

The lateral approach relies on an atraumatic elevation of the vastus lateralis from the lateral aspect of the distal femur, and a lateral arthrotomy for joint visualization. Articular reduction and lateral plate application can both be achieved with the same approach. Additionally, the approach can be extended proximally (see the lateral approach to the femoral shaft).

The approach can also be used without an arthrotomy if the articular surface is not fractured.

Prophylactic antibiotics

Antibiotics are administered according to local antibiotic policy and specific patient requirements.

Many surgeons use gram-positive prophylactic antibiotic cover for closed fractures, adding gram-negative prophylactic cover for open fractures. Always remember that antibiotic therapy will never compensate for poor surgical technique.