Approaches Flashcards

1
Q

What is the Smith-Peterson approach?

A

Anterior approach to the hip

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2
Q

What is special about the Smith-Peterson approach to the hip?

A

Only one with a true internervous plane

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3
Q

What is the internervous plane of the Smith-Peterson Approach?

A

Femoral nerve & Superior gluteal nerve
Superficial: Sartorius & TFL
Deep: Rectus femoris & gluteus medius

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4
Q

Define the Smith-Peterson approach with respects to Position, Incision, Plane and Dangers

A

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

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5
Q

What is the Watson-Jones approach to the hip?

A

Anterolateral approach

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6
Q

What is the interval in the Watson-Jones approach to the hip?

A

No internervous plane

- Intermuscular plane between TFL and gluteus medius (superior gluteal nerve)

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7
Q

Describe the Watson-Jones approach to the hip with respect to position, incision, plane and dangers:

A

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

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8
Q

What is the Hardinge approach to the hip?

A

Lateral approach to the hip

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9
Q

What is the plane for the Hardinge approach?

A

No internervous plane

- Transgluteal approach through gluteus medius and minimus

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10
Q

Describe the Hardinge approach with respect to position, incision, plane and dangers:

A

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

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11
Q

What is the Southern or Moore’s approach to the hip?

A

Posterior approach to the hip

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12
Q

What is the interval of the Moore’s/Southern approach to the hip?

A

No internervous plane

- Intermuscular plane: gluteus maximus split

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13
Q

Describe the posterior approach to the hip in terms of position, incision, plane and dangers

A

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

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14
Q

Why should the quadratus femoris not be detached, if possible:

A

Branches of the lateral circumflex artery reside there and will bleed if cut

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15
Q

How do you put the shorts external rotators further away from the sciatic nerve?

A

Internally rotate the hip before cutting the short external rotators

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16
Q

What are the components of the short external rotators of the hip?

A
Piriformis
Gemellus superior
Obturator internus
Gemellus inferior
Obturator externus
Quadratus femoris
17
Q

What happens if the sciatic nerve looks too small when you encounter it?

A

It likely has branched early into tibial and peroneal components:
- Look for the other branch!

18
Q

Should you dissect out the sciatic nerve in this approach?

A

No - may cause excessive bleeding from vessels surrounding it