Medial Knee Approach: An Anatomical Study of MIPO in Medial Femoral Condylar Fracture

Norachart Sirisreetreerux, Babar Shafiq, Greg Osgood, Erik Anton Hasenboehler

Research output: Contribution to journalArticle

Abstract

OBJECTIVES:: To determine the location of distal medial neurovascular structures, identifying a medial “safe zone” for minimally invasive plate osteosynthesis to treat displaced femoral condylar fractures. METHODS:: Eleven uninjured lower-half torsos were dissected on the bilateral medial lower thigh. A longitudinal incision was made at the midsagittal plane of the medial thigh starting 1 cm proximal to the knee joint and extending to the proximal one-third of the femur. Superficial and deep neurovascular structures were dissected. Distances to the medial vastus and adductor compartment were measured. RESULTS:: Mean distances were 160 ± 31.4 mm from the adductor tubercle to Hunter’s canal; 94 ± 18.3 mm from adductor tubercle to adductor hiatus; 31.8 ± 9.21 mm from Hunter’s canal to the femoral shaft; and 31.7 ± 7.78 mm from adductor hiatus to femoral shaft. All specimens had a descending genicular artery (DGA) with a mean distance to the adductor tubercle of 98.4 ± 16.0 mm. The muscular branch of the DGA crossed the femoral shaft at approximately 50 mm from the adductor tubercle; the osteoarticular branch ran along the adductor magnus tendon. The nerve to the vastus medialis was at the posterior border of the vastus medialis, entering at a mean 143 ± 63.0 mm from the adductor tubercle. CONCLUSIONS:: Minor neurovascular braches of the DGA may be vulnerable during medial femoral condyle plating. Careful blunt dissection, proper instrumentation, and plate length within 160 mm allow distal medial femur fixation without additional proximal dissection.

Original languageEnglish (US)
JournalJournal of Orthopaedic Trauma
DOIs
StateAccepted/In press - Jul 21 2016

Fingerprint

Femoral Fractures
Thigh
Knee
Quadriceps Muscle
Femur
Dissection
Arteries
Torso
Femoral Artery
Knee Joint
Tendons
Bone and Bones

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{ac5063d470e044c7bba354012d4fbcfb,
title = "Medial Knee Approach: An Anatomical Study of MIPO in Medial Femoral Condylar Fracture",
abstract = "OBJECTIVES:: To determine the location of distal medial neurovascular structures, identifying a medial “safe zone” for minimally invasive plate osteosynthesis to treat displaced femoral condylar fractures. METHODS:: Eleven uninjured lower-half torsos were dissected on the bilateral medial lower thigh. A longitudinal incision was made at the midsagittal plane of the medial thigh starting 1 cm proximal to the knee joint and extending to the proximal one-third of the femur. Superficial and deep neurovascular structures were dissected. Distances to the medial vastus and adductor compartment were measured. RESULTS:: Mean distances were 160 ± 31.4 mm from the adductor tubercle to Hunter’s canal; 94 ± 18.3 mm from adductor tubercle to adductor hiatus; 31.8 ± 9.21 mm from Hunter’s canal to the femoral shaft; and 31.7 ± 7.78 mm from adductor hiatus to femoral shaft. All specimens had a descending genicular artery (DGA) with a mean distance to the adductor tubercle of 98.4 ± 16.0 mm. The muscular branch of the DGA crossed the femoral shaft at approximately 50 mm from the adductor tubercle; the osteoarticular branch ran along the adductor magnus tendon. The nerve to the vastus medialis was at the posterior border of the vastus medialis, entering at a mean 143 ± 63.0 mm from the adductor tubercle. CONCLUSIONS:: Minor neurovascular braches of the DGA may be vulnerable during medial femoral condyle plating. Careful blunt dissection, proper instrumentation, and plate length within 160 mm allow distal medial femur fixation without additional proximal dissection.",
author = "Norachart Sirisreetreerux and Babar Shafiq and Greg Osgood and Hasenboehler, {Erik Anton}",
year = "2016",
month = "7",
day = "21",
doi = "10.1097/BOT.0000000000000659",
language = "English (US)",
journal = "Journal of Orthopaedic Trauma",
issn = "0890-5339",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Medial Knee Approach

T2 - An Anatomical Study of MIPO in Medial Femoral Condylar Fracture

AU - Sirisreetreerux, Norachart

AU - Shafiq, Babar

AU - Osgood, Greg

AU - Hasenboehler, Erik Anton

PY - 2016/7/21

Y1 - 2016/7/21

N2 - OBJECTIVES:: To determine the location of distal medial neurovascular structures, identifying a medial “safe zone” for minimally invasive plate osteosynthesis to treat displaced femoral condylar fractures. METHODS:: Eleven uninjured lower-half torsos were dissected on the bilateral medial lower thigh. A longitudinal incision was made at the midsagittal plane of the medial thigh starting 1 cm proximal to the knee joint and extending to the proximal one-third of the femur. Superficial and deep neurovascular structures were dissected. Distances to the medial vastus and adductor compartment were measured. RESULTS:: Mean distances were 160 ± 31.4 mm from the adductor tubercle to Hunter’s canal; 94 ± 18.3 mm from adductor tubercle to adductor hiatus; 31.8 ± 9.21 mm from Hunter’s canal to the femoral shaft; and 31.7 ± 7.78 mm from adductor hiatus to femoral shaft. All specimens had a descending genicular artery (DGA) with a mean distance to the adductor tubercle of 98.4 ± 16.0 mm. The muscular branch of the DGA crossed the femoral shaft at approximately 50 mm from the adductor tubercle; the osteoarticular branch ran along the adductor magnus tendon. The nerve to the vastus medialis was at the posterior border of the vastus medialis, entering at a mean 143 ± 63.0 mm from the adductor tubercle. CONCLUSIONS:: Minor neurovascular braches of the DGA may be vulnerable during medial femoral condyle plating. Careful blunt dissection, proper instrumentation, and plate length within 160 mm allow distal medial femur fixation without additional proximal dissection.

AB - OBJECTIVES:: To determine the location of distal medial neurovascular structures, identifying a medial “safe zone” for minimally invasive plate osteosynthesis to treat displaced femoral condylar fractures. METHODS:: Eleven uninjured lower-half torsos were dissected on the bilateral medial lower thigh. A longitudinal incision was made at the midsagittal plane of the medial thigh starting 1 cm proximal to the knee joint and extending to the proximal one-third of the femur. Superficial and deep neurovascular structures were dissected. Distances to the medial vastus and adductor compartment were measured. RESULTS:: Mean distances were 160 ± 31.4 mm from the adductor tubercle to Hunter’s canal; 94 ± 18.3 mm from adductor tubercle to adductor hiatus; 31.8 ± 9.21 mm from Hunter’s canal to the femoral shaft; and 31.7 ± 7.78 mm from adductor hiatus to femoral shaft. All specimens had a descending genicular artery (DGA) with a mean distance to the adductor tubercle of 98.4 ± 16.0 mm. The muscular branch of the DGA crossed the femoral shaft at approximately 50 mm from the adductor tubercle; the osteoarticular branch ran along the adductor magnus tendon. The nerve to the vastus medialis was at the posterior border of the vastus medialis, entering at a mean 143 ± 63.0 mm from the adductor tubercle. CONCLUSIONS:: Minor neurovascular braches of the DGA may be vulnerable during medial femoral condyle plating. Careful blunt dissection, proper instrumentation, and plate length within 160 mm allow distal medial femur fixation without additional proximal dissection.

UR - http://www.scopus.com/inward/record.url?scp=84979988163&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84979988163&partnerID=8YFLogxK

U2 - 10.1097/BOT.0000000000000659

DO - 10.1097/BOT.0000000000000659

M3 - Article

C2 - 27768679

AN - SCOPUS:84979988163

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

SN - 0890-5339

ER -