Anterior Trans-Muscular Approach to Hip (AP’s Access)

Objective: To introduce an anterior trans-muscular approach to the hip joint for intra-capsular neck femur (ICNF) fracture fixation. Design: Prospective study of 37 hips in 36 patients treated from January 2022 to December 2023. Patients were operated by anterior trans-muscular approach (AP’s Access) and fixed by Cancellous Cannulated screws or by angle stable side plate construct (DHS, FNS) along with anti-rotation screws with or without anteromedial buttress plate. Aim was to achieve anatomic reduction, absolute stability, compression at fracture site without losing neck length. Regular follow up for wound healing, fixation failure, union of fracture, osteonecrosis, infection and other possible complications done. Setting: Single center Patient Selection Criteria: Patients between 18 to 65 years with AO/OTA type 31B1, 31B2, 31B3 & Gardens type III & type IV ICNF fracture included with minimum follow-up of 24 months. Pathological fractures and previous hip surgery patients were excluded. Outcome Measures and Comparisons: Garden’s alignment index (GAI) used to assess the quality of reduction. Harris Hip Score (HHS) used for functional assessment. Results: “AP’s Access” gives excellent exposure and ease of reduction. Out of 37 hips 36 went on to unite with one hip requiring arthroplasty. According to GAI, grade I reduction in 28 and grade II in 9 patients. HHS score suggests excellent outcome in 28, good in 5, fair in 2 and poor in 1 patient. No patient had limp, infection, paraesthesia, thromboembolism. Conclusions: “AP’s Access” is an anterior trans-muscular approach with a feasible modification of established approaches which addresses the apprehensions related with other anterior approaches and showing early promising results. Level of Evidence – Level II