surgical approaches Flashcards
what are the indications for the watson jones approach to the hip?
expose hip
trauma THR
Elective THR
hemiarthroplasty
what is the intramuscular plane in the watson jones appraoch to the hip?
TFL (superior gluteal nerve)
Gluteus medius (superior gluteal nerve)
where is the incision made for the watson jones approach?
centred over tip of GT, 2/3 anterior to GT, 1/3 posterior to GT
in what position is the patient positioned for the watson jones approach?
on the side with blocks
where is the incision made for the anterior approach to the hip?
anterior half iliac crest - ASIS - proximal femur
what structures are involved in superficial dissection in the anterior approach to the hip?
Sartorius (medially)
TFL (Laterally)
what structures are involved in deep dissection in the anterior approach to the hip?
rectus femoris (medially)
Gluteus medius (laterally)
where is the incision made in the lateral approach to the hip?
Centred over GT
5cm proximal - down line of femur
what is the internervous plane in the lateral approach to the hip?
No true internervous plane
what is the intermuscular plane in the lateral approach to the hip?
Gluteus medius
Vastus lateralis
what is involved in superficial dissection in the lateral approach to the hip?
Split fascia lata
what is involved in deep dissection in the lateral approach to the hip?
Split Gluteus Medius + extend into vastus lateralis
Capsulotomy
what structures are at risk in the lateral approach to the hip?
Superior gluteal nerve
Femoral nerve
in what position would you place the patient in the watson jones (anterolateral) approach to the hip?
Lateral
what is the intermuscular plane in the watson jones (anterolateral) approach to the hip?
Tensor Fascia Lata (superior gluteal nerve)
Gluteus Medius (superior gluteal nerve)
where is the incision made in the anterolateral approach to the hip?
Start 2.5cm posterior + distal to ASIA -> Centre over GT down femur
what structures are invovled in superficial dissection in the anterolateral appraoch to the femur?
Fascia Lata
what structures are invovled in deep dissection in the anterolateral appraoch to the femur?
Death Abductor mechanism, capsulotomy
what structures are at risk in the anterolateral approach to the femur?
Femoral nerve, artery, vein
what are the indications for the posterior approach to the hip?
THA, Hip Hemiarthroplasty
What position should the patient be in for the posterior approach to the hip?
Lateral
(Prone)
what is the internervous plane in the posterior approach to the hip?
No true internervous plane
what is the intermuscular plane in the posterior approach to the hip?
Gluteus maximus along its fibres
(inferior gluteal nerve)
where is the incision made in the posterior approach to the hip?
10-15cm curved incision 1inch posterior to posterior edge of greater trochanter down shaft of femur
what structures are involved in superficial dissection in the posterior approach to the hip?
Fascia Lata
Split fibres of Gluteus Medius
what structures are involved in the deep dissection in the posterior approach to the hip?
Detach Short External rotators
(internally rotate hip)
Capsulotomy
what structures are at risk in the posterior approach to the hip?
Sciatic nerve
inferior gluteal nerve
Superior gluteal artery and nerve
femoral vessels
what must a patient always be prior to beginning surgical approach?
Appropriately marked, consented and WHO checklisted patient
to what pressure is the tourniquet usually inflated in upper limb procedures?
250mmHg
to what pressure is the tourniquet usually inflated in lower limb procedures?
300mmHg
what are the indications for FCR approach to the wrist?
ORIF of radius/carpus
in what position is the patient in for the FCR approach to the wrist?
Patient Supine with Arm board + tourniquet
what is the internervous plane for the FCR approach to the wrist?
FCR - median nerve
FPL - anterior interosseous nerve
what structures are involved in the superficial dissection in the FCR approach to the wrist?
Skin, fat
Incise FCR tendon sheath
what structures are involved in the deep dissection in the FCR approach to the wrist?
Identify FPL - retract ulnarly
PQ - list with L shaped incision to exposure distal radius
what structures are at risk in the FCR approach to the wrist?
Median nerve
Radial artery
what are the indications for the deltopectoral approach to the shoulder?
Shoulder arthroplasty
Proximal humerus fractures
Access to joint
in what position should the patient be in for the deltopectoral approach to the shoulder?
Beachchair or supine with ipsilateral scapular block
what is the internervous plane for the deltopectoral approach to the shoulder?
Deltoid - axillary nerve
Pec major - medial + lateral pectoral nerves
where is the incision made for the deltopectoral appraoch to the shoulder?
Deltopectoral groove
(coracoid - humerus)
what structures are involved in the superficial dissection in the deltopectoral approach to the shoulder?
Deltopectoral Fascia
cephalic vein
what structures are involved in the deep dissection in the deltopectoral approach to the shoulder?
Conjoint tendon (retract medially)
Subscapularis tendon cut
Capsule
what structures are at risk in the deltopectoral approach to the shoulder?
Musculocutaneous nerve
Axillary nerve
Cephalic vein
anterior circumflex humeral vessels
where does the musculocutaneous nerve enter the biceps?
5-8cm distal to coracoid medially
how is the patient positioned for the lateral appraoch to the ankle?
Supine, Sandbag ipsilateral buttock, radiolucent block, tourniquet
what structures are at risk in the lateral approach to the ankle?
Sural Nerve
Short Saphenous Nerve
Terminal branches of peroneal artery
Superficial peroneal nerve
where does the superficial peroneal nerve lie in relation to the fibula?
10cm proximal, crosses from lateral to anterior compartment
where is the incision made in the lateral approach to the ankle?
longitudinal incision along posterior margin of fibula, centred on fracture site
what structures are involved in superficial dissection in the lateral approach to the ankle?
Skin flaps elevated
what structures are involved in dissection in the lateral approach to the ankle?
Incise periosteum along subcutaneous surface of fibula
where do you mark the incision for carpal tunnel decompression?
Mark incision at intersection of Kaplans cardinal line and radial border of 4th ray ending at the wrist crease
what structures are encountered in superficial dissection of the carpal tunnel?
Skin, subcutaneous fat, palmar fascia, palmaris brevis
how do you protect the median nerve when perfoming carpal tunnel decompression?
Place mcdonald/retractor beneath TCL
what is kaplans cardinal line?
line drawn from the apex of the interdigital fold between the thumb and index finger toward the ulnar side of the hand
which vertebrae have a bifid spinous process?
cervical
which vertebrae have a transverse foramen?
Cervical
which vertebrae have a triangular vertebral foramen?
Cervical
what do the facets on the transverse processes of the thoracic vertebrae articulate with?
Tubercles of ribs (except 11th and 12th)
what do the facets of the vertebral bodies of the thoracic vertebrae articulate with?
Head of ribs
Cauda equina contains which nerve roots?
L2-S5
what dermatome supplies dorsum of the foot?
L5
which myotome is associated with foot eversion?
S1
what is the superior border of the antecubital fossa?
imagine line drawn between medial and lateral condyles
what is the lateral border of the ACF?
Brachioradialis
what is the medial border of the ACL?
Pronator teres
what is the floor of the ACF?
Supinator, brachialis
what is the floor of the ACF?
Supinator, brachialis
