Minimal Access Approach to Proximal femur

Position

• supine
• traction table
• leg adducted
• position checked with II

Landmarks

• greater trochanter
• ASIS
• Shaft of femur
• Patella
• Mark entry point using guide wire in AP & lateral planes

Incision

• Longitudina incision centered on point intersecting
  • Midshaft of femur
  • Perpendicular line from ASIS

Internervous Plane

• Split of Gluteus maximus & medius

Superficial Dissection

• Subcutaneous fat & fascia
• Using blunt dissection
  • Split the fibres of gluteus maximus & medius

Deep Dissection

• Feel for tip of greater trochanter