Coxa vara, coxa valga, hip dysplasia (femoral component), Perthes sequelae
Danger Structures
Sciatic nerve - 15-30mm posterior to hip joint depending on approach and position, injury causes foot drop and sensory loss - EXAM KEY: identify and protect, keep hip flexed to relax nerve
Femoral neurovascular bundle - 30-50mm medial to anterior hip joint, injury catastrophic - EXAM KEY: stay on bone with anterior retractors
Superior gluteal neurovascular bundle - 30-50mm proximal to greater trochanter, injury causes abductor weakness - EXAM KEY: avoid proximal dissection, stay in safe zone
Lateral femoral cutaneous nerve - variable position 20-50mm from anterior incisions, injury causes meralgia paresthetica - EXAM KEY: protect when visible
Medial femoral circumflex artery - main blood supply to femoral head, at risk during capsulotomy - EXAM KEY: careful dissection around posterior femoral neck
Visual Atlas
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Step-by-Step Technique
1
Lateral incision over proximal femur
Surgeon's Tip
EXAM KEY: Critical step in Proximal Femoral Osteotomy - ensure proper technique and visualization.
Danger Zone
Skin necrosis from excessive tension
Damage to underlying structures
2
Split vastus lateralis or elevate from intermuscular septum
Surgeon's Tip
EXAM KEY: Critical step in Proximal Femoral Osteotomy - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
3
Apply blade plate or angle plate guide
Surgeon's Tip
EXAM KEY: Critical step in Proximal Femoral Osteotomy - ensure proper technique and visualization.
Danger Zone
Malposition of hardware
Damage to adjacent structures
4
Insert guide wire for plate at calculated angle
Surgeon's Tip
EXAM KEY: Critical step in Proximal Femoral Osteotomy - ensure proper technique and visualization.
Danger Zone
Malposition of hardware
Damage to adjacent structures
5
Pre-operative templating essential for correction angle
Surgeon's Tip
EXAM KEY: Critical step in Proximal Femoral Osteotomy - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
6
Insert blade plate chisel along guide wire
Surgeon's Tip
EXAM KEY: Critical step in Proximal Femoral Osteotomy - ensure proper technique and visualization.
Danger Zone
Malposition of hardware
Damage to adjacent structures
7
Mark osteotomy level distal to plate entry
Surgeon's Tip
EXAM KEY: Critical step in Proximal Femoral Osteotomy - ensure proper technique and visualization.