Approaches Flashcards
What is the Smith-Peterson approach?
Anterior approach to the hip
What is special about the Smith-Peterson approach to the hip?
Only one with a true internervous plane
What is the internervous plane of the Smith-Peterson Approach?
Femoral nerve & Superior gluteal nerve
Superficial: Sartorius & TFL
Deep: Rectus femoris & gluteus medius
Define the Smith-Peterson approach with respects to Position, Incision, Plane and Dangers
Position: Supine
Incision: anterior half of iliac crest to ASIS, then turn down on anterior thigh heading towards lateral patella 8-10cm
Internervous plane: femoral nerve & superior gluteal
- Superficial: Sartorius and TFL
- Deep: Rectus femoris & gluteus medius
Dangers:
- LFCN - during superficial dissection - runs in Sartorial fascia, 2cm below ASIS
- Branch of lateral femoral circumflex artery: in the plane between the TFL and Sartorius
What is the Watson-Jones approach to the hip?
Anterolateral approach
What is the interval in the Watson-Jones approach to the hip?
No internervous plane
- Intermuscular plane between TFL and gluteus medius (superior gluteal nerve)
Describe the Watson-Jones approach to the hip with respect to position, incision, plane and dangers:
Position: Supine with a bump under ipsilateral side
Incision: Lateral incision centered over posterior aspect of GT
Plane: Intermuscular plane: gluteus medius and TFL (both superior gluteal nerve)
Dangers:
- Contents of femoral canal: with too vigorous retraction
- Fractures of the femoral shaft during dislocation
What is the Hardinge approach to the hip?
Lateral approach to the hip
What is the plane for the Hardinge approach?
No internervous plane
- Transgluteal approach through gluteus medius and minimus
Describe the Hardinge approach with respect to position, incision, plane and dangers:
Position: Lateral (or supine)
Incision: Straight incision centered over the center of GT
Plane: no internervous plane
- Through gluteus medius and minimus
Dangers:
- Superior gluteal nerve: 3cm above gluteus medius attachment on GT
- Transverse branch of lateral femoral circumflex artery cut as vastus lateralis is mobilized
- Femoral canal contents with vigorous retraction
What is the Southern or Moore’s approach to the hip?
Posterior approach to the hip
What is the interval of the Moore’s/Southern approach to the hip?
No internervous plane
- Intermuscular plane: gluteus maximus split
Describe the posterior approach to the hip in terms of position, incision, plane and dangers
Position: lateral with affected side up
Incision: Incision starts 6-8cm proximal and posterior to GT, curves down along the line of the femur centered over the posterior aspect of the GT
Plane: G. Maximus split, then through SERs
Dangers: Sciatic nerve, inferior gluteal artery
Why should the quadratus femoris not be detached, if possible:
Branches of the lateral circumflex artery reside there and will bleed if cut
How do you put the shorts external rotators further away from the sciatic nerve?
Internally rotate the hip before cutting the short external rotators