surgical approaches

Question 1

what are the indications for the watson jones approach to the hip?

Answer 1

expose hip
trauma THR
Elective THR
hemiarthroplasty

Question 2

what is the intramuscular plane in the watson jones appraoch to the hip?

Answer 2

TFL (superior gluteal nerve)
Gluteus medius (superior gluteal nerve)

Question 3

where is the incision made for the watson jones approach?

Answer 3

centred over tip of GT, 2/3 anterior to GT, 1/3 posterior to GT

Question 4

in what position is the patient positioned for the watson jones approach?

Answer 4

on the side with blocks

Question 5

where is the incision made for the anterior approach to the hip?

Answer 5

anterior half iliac crest - ASIS - proximal femur

Question 6

what structures are involved in superficial dissection in the anterior approach to the hip?

Answer 6

Sartorius (medially)
TFL (Laterally)

Question 7

what structures are involved in deep dissection in the anterior approach to the hip?

Answer 7

rectus femoris (medially)
Gluteus medius (laterally)

Question 8

where is the incision made in the lateral approach to the hip?

Answer 8

Centred over GT
5cm proximal - down line of femur

Question 9

what is the internervous plane in the lateral approach to the hip?

Answer 9

No true internervous plane

Question 10

what is the intermuscular plane in the lateral approach to the hip?

Answer 10

Gluteus medius
Vastus lateralis

Question 11

what is involved in superficial dissection in the lateral approach to the hip?

Answer 11

Split fascia lata

Question 12

what is involved in deep dissection in the lateral approach to the hip?

Answer 12

Split Gluteus Medius + extend into vastus lateralis
Capsulotomy

Question 13

what structures are at risk in the lateral approach to the hip?

Answer 13

Superior gluteal nerve
Femoral nerve

Question 14

in what position would you place the patient in the watson jones (anterolateral) approach to the hip?

Answer 14

Lateral

Question 15

what is the intermuscular plane in the watson jones (anterolateral) approach to the hip?

Answer 15

Tensor Fascia Lata (superior gluteal nerve)
Gluteus Medius (superior gluteal nerve)

Question 16

where is the incision made in the anterolateral approach to the hip?

Answer 16

Start 2.5cm posterior + distal to ASIA -> Centre over GT down femur

Question 17

what structures are invovled in superficial dissection in the anterolateral appraoch to the femur?

Answer 17

Fascia Lata

Question 18

what structures are invovled in deep dissection in the anterolateral appraoch to the femur?

Answer 18

Death Abductor mechanism, capsulotomy

Question 19

what structures are at risk in the anterolateral approach to the femur?

Answer 19

Femoral nerve, artery, vein

Question 20

what are the indications for the posterior approach to the hip?

Answer 20

THA, Hip Hemiarthroplasty

Question 21

What position should the patient be in for the posterior approach to the hip?

Answer 21

Lateral
(Prone)

Question 22

what is the internervous plane in the posterior approach to the hip?

Answer 22

No true internervous plane

Question 23

what is the intermuscular plane in the posterior approach to the hip?

Answer 23

Gluteus maximus along its fibres
(inferior gluteal nerve)

Question 24

where is the incision made in the posterior approach to the hip?

Answer 24

10-15cm curved incision 1inch posterior to posterior edge of greater trochanter down shaft of femur

Question 25

what structures are involved in superficial dissection in the posterior approach to the hip?

Answer 25

Fascia Lata Split fibres of Gluteus Medius

Question 26

what structures are involved in the deep dissection in the posterior approach to the hip?

Answer 26

Detach Short External rotators (internally rotate hip) Capsulotomy

Question 27

what structures are at risk in the posterior approach to the hip?

Answer 27

Sciatic nerve inferior gluteal nerve Superior gluteal artery and nerve femoral vessels

Question 28

what must a patient always be prior to beginning surgical approach?

Answer 28

Appropriately marked, consented and WHO checklisted patient

Question 29

to what pressure is the tourniquet usually inflated in upper limb procedures?

Answer 29

250mmHg

Question 30

to what pressure is the tourniquet usually inflated in lower limb procedures?

Answer 30

300mmHg

Question 31

what are the indications for FCR approach to the wrist?

Answer 31

ORIF of radius/carpus

Question 32

in what position is the patient in for the FCR approach to the wrist?

Answer 32

Patient Supine with Arm board + tourniquet

Question 33

what is the internervous plane for the FCR approach to the wrist?

Answer 33

FCR - median nerve FPL - anterior interosseous nerve

Question 34

what structures are involved in the superficial dissection in the FCR approach to the wrist?

Answer 34

Skin, fat Incise FCR tendon sheath

Question 35

what structures are involved in the deep dissection in the FCR approach to the wrist?

Answer 35

Identify FPL - retract ulnarly PQ - list with L shaped incision to exposure distal radius

Question 36

what structures are at risk in the FCR approach to the wrist?

Answer 36

Median nerve Radial artery

Question 37

what are the indications for the deltopectoral approach to the shoulder?

Answer 37

Shoulder arthroplasty Proximal humerus fractures Access to joint

Question 38

in what position should the patient be in for the deltopectoral approach to the shoulder?

Answer 38

Beachchair or supine with ipsilateral scapular block

Question 39

what is the internervous plane for the deltopectoral approach to the shoulder?

Answer 39

Deltoid - axillary nerve Pec major - medial + lateral pectoral nerves

Question 40

where is the incision made for the deltopectoral appraoch to the shoulder?

Answer 40

Deltopectoral groove (coracoid - humerus)

Question 41

what structures are involved in the superficial dissection in the deltopectoral approach to the shoulder?

Answer 41

Deltopectoral Fascia cephalic vein

Question 42

what structures are involved in the deep dissection in the deltopectoral approach to the shoulder?

Answer 42

Conjoint tendon (retract medially) Subscapularis tendon cut Capsule

Question 43

what structures are at risk in the deltopectoral approach to the shoulder?

Answer 43

Musculocutaneous nerve Axillary nerve Cephalic vein anterior circumflex humeral vessels

Question 44

where does the musculocutaneous nerve enter the biceps?

Answer 44

5-8cm distal to coracoid medially

Question 45

how is the patient positioned for the lateral appraoch to the ankle?

Answer 45

Supine, Sandbag ipsilateral buttock, radiolucent block, tourniquet

Question 46

what structures are at risk in the lateral approach to the ankle?

Answer 46

Sural Nerve Short Saphenous Nerve Terminal branches of peroneal artery Superficial peroneal nerve

Question 47

where does the superficial peroneal nerve lie in relation to the fibula?

Answer 47

10cm proximal, crosses from lateral to anterior compartment

Question 48

where is the incision made in the lateral approach to the ankle?

Answer 48

longitudinal incision along posterior margin of fibula, centred on fracture site

Question 49

what structures are involved in superficial dissection in the lateral approach to the ankle?

Answer 49

Skin flaps elevated

Question 50

what structures are involved in dissection in the lateral approach to the ankle?

Answer 50

Incise periosteum along subcutaneous surface of fibula

Question 51

where do you mark the incision for carpal tunnel decompression?

Answer 51

Mark incision at intersection of Kaplans cardinal line and radial border of 4th ray ending at the wrist crease

Question 52

what structures are encountered in superficial dissection of the carpal tunnel?

Answer 52

Skin, subcutaneous fat, palmar fascia, palmaris brevis

Question 53

how do you protect the median nerve when perfoming carpal tunnel decompression?

Answer 53

Place mcdonald/retractor beneath TCL

Question 54

what is kaplans cardinal line?

Answer 54

line drawn from the apex of the interdigital fold between the thumb and index finger toward the ulnar side of the hand

Question 55

which vertebrae have a bifid spinous process?

Answer 55

cervical

Question 56

which vertebrae have a transverse foramen?

Answer 56

Cervical

Question 57

which vertebrae have a triangular vertebral foramen?

Answer 57

Cervical

Question 58

what do the facets on the transverse processes of the thoracic vertebrae articulate with?

Answer 58

Tubercles of ribs (except 11th and 12th)

Question 59

what do the facets of the vertebral bodies of the thoracic vertebrae articulate with?

Answer 59

Head of ribs

Question 60

Cauda equina contains which nerve roots?

Answer 60

L2-S5

Question 61

what dermatome supplies dorsum of the foot?

Answer 61

L5

Question 62

which myotome is associated with foot eversion?

Answer 62

S1

Question 63

what is the superior border of the antecubital fossa?

Answer 63

imagine line drawn between medial and lateral condyles

Question 64

what is the lateral border of the ACF?

Answer 64

Brachioradialis

Question 65

what is the medial border of the ACL?

Answer 65

Pronator teres

Question 66

what is the floor of the ACF?

Answer 66

Supinator, brachialis

Question 67

what is the floor of the ACF?

Answer 67

Supinator, brachialis