Executive Editor: Chris Colton, Rick Buckley

Authors: Peter V Giannoudis, Hans Christoph Pape, Michael Sch├╝tz

Femur shaft

back to skeleton

Glossary

MIO approach
Minimally invasive osteosynthesis – Approach femur enlarge

Principles

The advantages of minimally invasive plate osteosynthesis of the femoral shaft are lessening of the extent of muscle detachment and reduced compromise of bone vascularity.

Approaches for minimally invasive plate osteosynthesis are usually performed laterally. They vary according to the fracture location: proximal (segment 1), mid-shaft (segment 2), or distal femur (segment 3) sections.

Thorough preoperative planning is compulsory in order to define the necessary specific approach locations.


Minimally invasive osteosynthesis – Approach femur – Sub trochanteric - Incision enlarge

MIO approach to the subtrochanteric region

The lateral proximal incision starts at the greater trochanter and continues distally as far as needed.


Minimally invasive osteosynthesis – Approach femur – Sub trochanteric - Exposure enlarge

The fascia lata is incised with a scalpel and split with scissors parallel to the skin incision along the fibers.

The muscle fascia over the vastus lateralis is exposed.


Minimally invasive osteosynthesis – Approach femur – Sub trochanteric - Exposure enlarge

If exposure of the proximal femoral shaft is necessary, the origin of the vastus lateralis must be identified.

The muscle can be retracted anteriorly with an L-shape incision down to the bone. It is then dissected off with the periosteal elevator.


Minimally invasive osteosynthesis – Approach femur – Sub trochanteric - Exposure enlarge

The proximal femoral shaft is exposed after performing the L-shaped extraperiosteal detachment of the vastus lateralis. The vertical part of the incision lies in the interval between gluteus medius and vastus lateralis.


Minimally invasive osteosynthesis – Approach femur – Midshaft - Incision enlarge

MIO approach to the femoral midshaft

A short, or even a stab, incision is made along an imaginary line between the lateral femoral epicondyle and the greater trochanter.

The starting point and the length of the incision depend on the operational requirements for the minimally invasive procedure.


Minimally invasive osteosynthesis – Approach femur – Midshaft - Dissection enlarge

The fascia lata is incised and the muscle fascia of the vastus lateralis is exposed.


Minimally invasive osteosynthesis – Approach femur – Midshaft – Vastus lateralis enlarge

The muscle fascia of the vastus lateralis is carefully incised.


Minimally invasive osteosynthesis – Approach femur – Midshaft - Dissection enlarge

This small lateral incision provides enough access but avoids large incisions and devascularization of muscle. 


Minimally invasive osteosynthesis – Approach femur – Midshaft - Dissection enlarge

Blunt dissection is carried directly through the belly of the vastus lateralis muscle to bone.


Minimally invasive osteosynthesis – Approach femur – Midshaft - Exposure enlarge

The use of two Hohmann retractors is recommended - one anterior and one posterior - for a secure exposure of the femoral shaft. These Hohmann retractors also ensure appropriate plate positioning on the femur.


Minimally invasive osteosynthesis – Approach femur – Midshaft – Distal femoral shaft enlarge

MIO approach to the distal femoral shaft

An incision is made laterally as far as the femoral epicondyle distally, directed towards Gerdy’s tubercle.

The starting location and the length of the incision can be adapted to suit operational requirements.


Minimally invasive osteosynthesis – Approach femur – Midshaft – Distal femoral shaft enlarge

The fascia lata is incised and split along its fibers, parallel to the skin incision.


Minimally invasive osteosynthesis – Approach femur – Midshaft – Distal femoral shaft enlarge

The distal femur is exposed as far as the distal margin of the vastus lateralis muscle. The plane between the femur and vastus lateralis muscle is the entry point for the plate.

v2.0 2018-07-05