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Orthopaedics ST3 > surgical approaches > Flashcards

surgical approaches Flashcards

1
Q

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

A

expose hip
trauma THR
Elective THR
hemiarthroplasty

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2
Q

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

A

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

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3
Q

where is the incision made for the watson jones approach?

A

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

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4
Q

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

A

on the side with blocks

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5
Q

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

A

anterior half iliac crest - ASIS - proximal femur

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6
Q

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

A

Sartorius (medially)
TFL (Laterally)

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7
Q

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

A

rectus femoris (medially)
Gluteus medius (laterally)

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8
Q

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

A

Centred over GT
5cm proximal - down line of femur

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9
Q

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

A

No true internervous plane

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10
Q

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

A

Gluteus medius
Vastus lateralis

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11
Q

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

A

Split fascia lata

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12
Q

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

A

Split Gluteus Medius + extend into vastus lateralis
Capsulotomy

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13
Q

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

A

Superior gluteal nerve
Femoral nerve

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14
Q

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

A

Lateral

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15
Q

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

A

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

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16
Q

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

A

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

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17
Q

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

A

Fascia Lata

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18
Q

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

A

Death Abductor mechanism, capsulotomy

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19
Q

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

A

Femoral nerve, artery, vein

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20
Q

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

A

THA, Hip Hemiarthroplasty

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21
Q

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

A

Lateral
(Prone)

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22
Q

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

A

No true internervous plane

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23
Q

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

A

Gluteus maximus along its fibres
(inferior gluteal nerve)

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24
Q

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

A

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

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25
Q

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

A

Fascia Lata
Split fibres of Gluteus Medius

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26
Q

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

A

Detach Short External rotators
(internally rotate hip)
Capsulotomy

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27
Q

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

A

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

28
Q

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

A

Appropriately marked, consented and WHO checklisted patient

29
Q

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

A

250mmHg

30
Q

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

A

300mmHg

31
Q

what are the indications for FCR approach to the wrist?

A

ORIF of radius/carpus

32
Q

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

A

Patient Supine with Arm board + tourniquet

33
Q

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

A

FCR - median nerve
FPL - anterior interosseous nerve

34
Q

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

A

Skin, fat
Incise FCR tendon sheath

35
Q

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

A

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

36
Q

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

A

Median nerve
Radial artery

37
Q

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

A

Shoulder arthroplasty
Proximal humerus fractures
Access to joint

38
Q

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

A

Beachchair or supine with ipsilateral scapular block

39
Q

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

A

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

40
Q

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

A

Deltopectoral groove
(coracoid - humerus)

41
Q

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

A

Deltopectoral Fascia
cephalic vein

42
Q

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

A

Conjoint tendon (retract medially)
Subscapularis tendon cut
Capsule

43
Q

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

A

Musculocutaneous nerve
Axillary nerve
Cephalic vein
anterior circumflex humeral vessels

44
Q

where does the musculocutaneous nerve enter the biceps?

A

5-8cm distal to coracoid medially

45
Q

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

A

Supine, Sandbag ipsilateral buttock, radiolucent block, tourniquet

46
Q

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

A

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

47
Q

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

A

10cm proximal, crosses from lateral to anterior compartment

48
Q

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

A

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

49
Q

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

A

Skin flaps elevated

50
Q

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

A

Incise periosteum along subcutaneous surface of fibula

51
Q

where do you mark the incision for carpal tunnel decompression?

A

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

52
Q

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

A

Skin, subcutaneous fat, palmar fascia, palmaris brevis

53
Q

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

A

Place mcdonald/retractor beneath TCL

54
Q

what is kaplans cardinal line?

A

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

55
Q

which vertebrae have a bifid spinous process?

A

cervical

56
Q

which vertebrae have a transverse foramen?

A

Cervical

57
Q

which vertebrae have a triangular vertebral foramen?

A

Cervical

58
Q

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

A

Tubercles of ribs (except 11th and 12th)

59
Q

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

A

Head of ribs

60
Q

Cauda equina contains which nerve roots?

A

L2-S5

61
Q

what dermatome supplies dorsum of the foot?

A

L5

62
Q

which myotome is associated with foot eversion?

A

S1

63
Q

what is the superior border of the antecubital fossa?

A

imagine line drawn between medial and lateral condyles

64
Q

what is the lateral border of the ACF?

A

Brachioradialis

65
Q

what is the medial border of the ACL?

A

Pronator teres

66
Q

what is the floor of the ACF?

A

Supinator, brachialis

67
Q

what is the floor of the ACF?

A

Supinator, brachialis

Orthopaedics ST3 (7 decks)

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