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Incise the skin over the middle third of the femur in a line between the anterosuperior iliac spine and the lateral margin of the patella. Incise the superficial and deep fasciae, and separate the rectus femoris and vastus lateralis muscles along their intermuscular septum. The vastus intermedius muscle is thus brought into view; divide it in the line of its fibers down to the femur. Then expose the femur by subperiosteal reflection of the incised vastus intermedius muscle.

The anterolateral approach exposes the middle third of the femur, but postoperative adhesions between the individual muscles of the quadriceps group and between the vastus intermedius and the femur may limit knee flexion. Therefore the quadriceps mechanism must be handled gently. Infections of the middle third of the shaft are best approached posterolaterally. When the shaft must be approached from the medial side, this anterolateral approach is indicated rather than an anteromedial one.

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