Anterolateral intermuscular approach for type A2 intertrochanteric fractures: a cadaveric study

Area of Science:

• Orthopedic Surgery
• Anatomy
• Biomechanics

Background:

• Traditional lateral surgical approaches for intertrochanteric fractures (ITF), particularly type A2, present disadvantages leading to intraoperative and postoperative complications.
• Minimally-invasive total hip arthroplasty (THA) using an anterolateral approach has been previously suggested for ITF treatment.

Purpose of the Study:

• To elucidate the anatomical basis for employing an anterolateral intermuscular approach in repairing type A2 intertrochanteric fractures (ITF).
• To evaluate the safety and efficacy of this novel approach compared to conventional methods.

Main Methods:

• A cadaveric dissection study involving 10 formalin-fixed Asian cadavers was performed.
• The anterolateral surgical approach was simulated to measure distances from critical neurovascular structures to the greater trochanter.
• Key measurements included the distances of the superior gluteal nerve and lateral femoral circumflex artery branches to the lateral protrusive point of the greater trochanter.

Main Results:

• The anterolateral intermuscular approach provided superior exposure of the greater trochanter, lesser trochanter, and femoral neck.
• The gluteus medius branch of the ascending branch of the lateral femoral circumflex artery (GMB-LFCA) and the most inferior branch of the superior gluteal nerve (MIB-SGN) were identified in the intermuscular plane.
• Mean distance from GMB-LFCA to the greater trochanter was 4.04 ± 1.00 cm; mean distance from MIB-SGN was 5.47 ± 1.61 cm.

Conclusions:

• The anterolateral intermuscular approach is anatomically feasible and relatively safe for treating type A2 intertrochanteric fractures.
• This approach offers excellent surgical exposure with potentially less soft-tissue damage compared to traditional methods.
• It represents a promising alternative surgical technique for type A2 ITF.