Erik Kubiak, MD | Andrea Attenasio, DO | Casey Roehr, MD | Jordan Miller, MD

It has been well established that the mechanism, injury pattern, and management of femoral neck fractures in young patients differs significantly from the same fracture occurring in the geriatric population. In the younger patient, these fractures tend to result from high energy mechanisms and follow a vertical fracture pattern, necessitating a fixation strategy that combats the significant sheer forces experienced across this fracture that causes them to be prone to failure of fixation, varus collapse, nonunion or malunion, and avascular necrosis. Recent studies have shown that using a medial buttress plate as supplemental fixation can improve clinical outcomes and decrease failure rates in these vertically oriented fracture patterns. This dissection video demonstrates a step by step anterior approach to the hip with an extended inferior capsular release. This allows for excellent exposure of the medial femoral neck to aid in appropriate placement and positioning of a medial buttress plate as supplemental fixation in the setting of a high energy, vertical femoral neck fracture pattern.

We start with the superficial dissection and identification of the lateral femoral cutaneous nerve. Deep dissection is performed by incising the tensor fascia and identifying and developing the intermuscular plane. The deep landmarks are identified including the lateral femoral circumflex vessels. This video also describes appropriate retractor placement in the deep interval in order to aid exposure. Next, we outline performing the capsulotomy to access the femoral neck, including the crucial inferior capsular release to allow adequate access to and exposure of the inferomedial femoral neck.

We demonstrate a vertical femoral neck fracture pattern and describe various reduction and fixation techniques that can be employed via this approach. Utilizing the extended release of the inferior capsule to the lesser trochanter while externally rotating the femur, we demonstrate the ability to access and place a medial buttress plate along the medial femoral neck via this dissection. Placing this buttress plate directly medial on the femoral neck has been demonstrated to result in a lower rate of fixation failure when compared to anteromedial or anterior placement. We conclude by confirming appropriate medial placement of our buttress plate via fluorographic imaging.