Lower Limb Flashcards
Positioning for direct lateral and posterolateral approaches?
Lateral decubitus position, figure of 4. Padding of pressures areas- knee to avoid damage to common peroneal nerve. Sterile prep of hip area with involved leg left free so that is can be manipulated.
Incision for direct lateral approach?
along femoral shaft over >trochanter
Muscles split in order?
Tensor fascia lata
Vastus lateralis
Gleuteus medius and minimus- superior gleuteal- L4-S1
Posterolateral approach incision
PSIS, >trochanter, Femoral shaft
Start lateral to >trochanter and curve to PSIS, continue down femoral shaft
First two muscles to be divided in posterolateral approach?
Tensor fascia lata
Gleteus maximus
Which nerve needs to identified? and what is its route in the pelvis?
Sciatic nerve- S1-3
Beneath piriformis and out through >sciatic foramen
What muscles are then dissected?
Short external rotators
Piriformis
Obturator Internus
Gemelli
What is the blood supply to the femoral head?
Retinacular vessels from medial and lateral circumflex off profunda femoris
Foveolar artery off obturator and internal illiac
Set up for medial parapatellar approach?
GA, supine, tourniquet- may fix quadriceps in shortened position.
Knee flexed at 90 degrees, with sandbag under heel for support
Incision landmarks medial parapatellar approach?
Patella, patella tendon, tibial tubercule
Incision for medial parapatellar approach?
5cm superior to superior pole of the patella to tibial tubercule, slightly oblique
Which tendon is incisied medial parapatellar approach?
Quadriceps tendon
Which neurovascular structure may be damaged medial parapatellar approach?
Infrapatellar branch of the spahenous nerve= loss of medial cutaneous sensation in the knee
What fat pad is deep to the patella?
Hoffa’s
Which artery can be damaged medial parapatellar approach?
Lateral genicular artery off popliteal artery
