Approaches

Question 1

When to use ilioinguinal approach?

Answer 1

Anterior wall and column fx
Anterior column + posterior hemitransverse
Majority of associated both column fx* (even in presence of posterior wall fx, posterior wall frag attached to ilium can be reduced thorough lateral ilium exposure*)

Question 2

Ilioinguinal approach

Answer 2

Skin, subQ fat, release abdominal and iliac form ilium, elevate iliac form internal ilia fossa to SI and pelvic brim, expose external oblique and recuts, divide aponeurosis one cm PROXIMAL TO EXTERNAL INGUINAL RING –> unroofs inguinal canal –> expose inguinal ligament –> PROTECT ILIOINGUINAL NERVE***

Isolate SPERMATIC CORD/ROUND LIGAMENT*** –> Penrose to retract, incise inguinal ligament

3 windows
Medial window: medial to external iliac vessels –> access to rami

Middle window: between external iliac vessels and iliopsoas
Access to pelvic brim, quadrilateral plate

Lateral window: lateral to iliopsoas
Access to quadrilateral plate, SI joint, iliac wing

Question 3

What nerve roots for LFCN?

Answer 3

L2-3***

Question 4

What position to have hand/wrist in when performing proximal extent of Henry approach?

Thompson?

Answer 4

Henry: between BR (radial) and PT (median) proximally –> SUPINATE arm/wrist to move PIN away from field***

Thompson –> dorsal approach (high PIN injury rates so not commonly done) –> PRONATE wrist***

Question 5

What structure is at risk when releasing iliopsoas tendon through a medial approach to hip?

Answer 5

Medial femoral circumflex artery***