Rudin (2016) — The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint.

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint.

·J Bone Joint Surg Am·2016·129 citations·Hip & Knee

Cadaveric dissection study (28 hemipelves, 18 donors) mapping the branching patterns and subcutaneous course of the lateral femoral cutaneous nerve (LFCN) specifically within the operative field of the anterior hip approach, to define which anatomical variants allow nerve preservation and which make injury unavoidable.

Study Snapshot

Design

Cadaveric study

Setting: University of Zurich, Zurich

Funding: None

Objective

Determine whether LFCN branching patterns affect injury risk during anterior hip approach

Outcome(s)

LFCN branching patterns and relationship to anterior hip approach

Subjects

28 cadaveric hemipelves from 18 donors

Exclusion

Prior trauma or surgery to femur/hip

Key Findings

Three LFCN branching patterns:
–Sartorius-type (36%) — dominant anterior branch along sartorius border, avoidable with lateral incision
–Posterior-type (32%) — strong posterior branch crossing tensor fasciae latae just distal to ASIS, vulnerable to proximal deep dissection
–Fan-type (32%)
LFCN injury is anatomically unavoidable in ~1/3 of anterior hip approaches (fan-type cases); with careful technique, total injury rate should not exceed one-third
62% of LFCN branches enter the thigh medial to the ASIS, 27% above, and 11% lateral — the lateral variant is especially dangerous when proximal approach extension is needed
LFCN consistently travels in the deep layer of a two-layered subcutaneous fat, divided by a membranous fascial sheet; superficial-only proximal incisions can protect the posterior branch
The study found LFCN division superior to the inguinal ligament in 50% of specimens — higher than the 28–38% reported by prior cadaveric studies, likely because dissection began intrapelvically

Clinical Relevance

When performing an anterior hip approach, keep the skin incision as lateral as possible (protects the anterior branch in sartorius-type anatomy) and limit any proximal extension to the superficial subcutaneous layer above the membranous fascial sheet (protects the posterior branch in posterior-type anatomy) — but if the patient ends up with fan-type LFCN anatomy, lateral thigh numbness is anatomically unavoidable and warrants preoperative counseling.

Supplemental

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint.

Rudin, Grob, et al.·J Bone Joint Surg Am·2016·129 citations·Hip & Knee

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint.

Study Snapshot

Key Findings

Clinical Relevance

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The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint.

Study Snapshot

Key Findings

Clinical Relevance

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