Distal femur

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	MIPO approach The lateral minimally invasive plate osteosynthesis (MIPO) approach combines a short version of the open lateral approach to the distal femur, a minimally invasive approach to the midshaft or, proximal femoral region and small 1.0 – 1.5 cm wide stab incisions.

	Lateral/anterolateral approach The lateral approach to the distal femur allows for visualization, reduction and fixation of simple articular fractures of the distal femur.

	Lateral parapatellar approach The lateral parapatellar approach provides a good view of the articular surface of the distal femur. With a longitudinal division of the quadriceps tendon and extensor mechanism, the patella can be dislocated medially.

	Arthroscopic approach The arthroscopic approach is only recommended in minimally, or nondisplaced, fractures in young patients. Advanced experience in arthroscopic surgery is essential.

	Medial approach The medial approach to the distal femur is useful to expose a medial distal femoral fractures, a Hoffa-type fracture, osteochondroma, or a neoplastic lesion of bone.

	Retrograde nailing approach Care should be taken with the approach for retrograde nailing as several anatomical structures are at risk. The most important potential hazard is damage to the posterior cruciate ligament.

	Posterior approach The neurovascular structures of the knee joint are at risk during the posterior approach. They are located between the two femoral condyles and the heads of the gastrocnemius muscle.

	Medial parapatellar approach Make a longitudinal, slightly oblique medial parapatellar incision along a line starting 5 cm above the superior pole of the patella to the tibial tubercle.

	Safe zones Inserting percutaneous instrumentation through safe zones reduces the risk of damage to neurovascular structures.

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v1.0 2008-12-03