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Sliding Trochanteric Osteotomy

- Discussion:
    - osteotomy is made in a manner which leaves the vastus lateralis and gluteus medius muscles are left attached to the osteotomy fragment;
    - has a lower incidence of abductor dysfunction and proximal migration of trochanter;
    - presence of an intact vastus helps not only to preserve blood supply to the trochanter but also to neutralize the forces tending to pull the 
            trochanter proximally and anteriorly;
    - this type of osteotomy facilitates visualization of the superior aspect of the hip capsule;

- Technique:
    - vastus lateralis it is elevated off the lateral and anterior aspect of the proximal femoral shaft;
           - it should be detached about 5 cm below its attachment to the vastus ridge;
    - greater trochanter is then cut either with the Gigli saw or by using an oscillating saw;
    - in the case of acetabular frx (using Kocher Langenbach approach), it is important to make the cut lateral to the insertion of the external
            rotators in order to avoid injury to the MFCA and blood supply to femoral hip;
    - protect the vastus lateralis w/ a blunt Homan retractor (leaving the intact connection w/ vastus lateralis);
    - once the bone has been detached, it can be slid forward by simply stretching the vastus to give very good proximal femoral exposure;
    - the gluteus medius and minimus are partially mobilized off of the ilium;
    - reflect the entire vatus trochanter abductor unit anteriorly to allow exposure of the hip

Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach.

Osteotomy of the trochanter in open reduction and internal fixation of acetabular fractures.