Introduction: Current Literature is sparse with respect to the optimum surgical approach for fixation of a fractured neck of Femur. A cadaveric study has been performed to determine the pattern of innervation of the Vastus Lateralis muscle. Results indicate that a muscle splitting technique may cause more nerve damage than a muscle reflection technique. The purpose of this study was to determine the clinical and neurophysiological effects of two different surgical approaches to the proximal femur.

Methods: Patients were randomised to receive either a Vastus splitting approach or a Vastus reflecting approach to the fractured femoral neck. The contralateral leg was used as the control for neurophysiological investigation. Needle electromyography was performed on both the operated and unoperated limbs within 2 weeks of surgery.

Results: 25 patients were included in the study randomisation. A total of 17 patients completed neurophysiological investigation, 8 in muscle reflection and 9 in muscle splitting groups. There was a significant reduction in femoral nerve conduction velocity compared to the unoperated control side in the muscle split group. This was also the case for amplitude of response measured in the Vastus muscle. The muscle reflection group showed no significant differences in these parameters compared to the unoperated side.

Conclusion: On the basis of the results of this study we recommend a Vastus Lateralis reflecting approach for proximal Femoral fracture fixation. The functional outcome of a muscle splitting approach remains unclear but could be investigated as part of a larger trial.