Introduction Provides exposure to hip joint ilium Indications THA open reduction of congenital hip dislocations synovial biopsies intra-articular fusions excision of pelvic tumors pelvic osteotomies irrigation and debridement of infected, native hip Planes Internervous plane-Superficial sartorius (femoral n.) tensor fasciae latae (superior gluteal n.) Internervous plane-Deep rectus femoris (femoral n.) gluteus medius (superior gluteal n.) Position and Preparation Anesthesia options include block vs. general anesthesia Position supine Approach Incision make incision from anterior half of iliac crest to ASIS from ASIS curve inferiorly in the direction of the lateral patella for 8-10 cm Superficial dissection identify gap between sartorius and tensor fasciae latae dissect through subcutaneous fat (avoid lateral femoral cutaneous n.) incise fascia on medial side of tensor fascia latae detach origin of tensor fasciae latae of iliac to develop internervous plane ligate the ascending branch of the lateral femoral circumflex artery (crosses gap between sartorius and tensor fascia latae) Deep dissection identify plane between rectus femoris and gluteus medius detach rectus femoris from both its origins retract rectus femoris and iliopsoas medially and gluteus medius laterally to expose the hip capsule adduct and externally rotate the hip to place the capsule on stretch incise capsule with a longitudinal or T-shaped capsular incision dislocate hip with external rotation after capsulotomy is complete Proximal extension indications bone graft harvest dissection extend proximal incision posteriorly along the iliac crest Distal extension indications intra-operative fracture of distal femur dissection lengthen skin incision downward along anterolateral aspect of thigh incise fascia latae in line with skin incision stay in the interval between the vastus lateralis and rectus femoris Dangers Lateral femoral cutaneous nerve reaches thigh by passing under inguinal ligament the course is variable and the LFCN can be seen passing medial or lateral to ASIS most commonly seen when incising fascia between the sartorius and the tensor fascia latae injury may lead to painful neuroma or decreased sensation on lateral aspect of thigh Femoral nerve should remain protected as long as you stay lateral to sartorius muscle Ascending branch of lateral femoral circumflex artery found proximally in the internervous plane between the tensor fascia latae and sartorius be sure to ligate to prevent excessive bleeding
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next (SBQ12TR.4) Which of the following statements about the lateral femoral cutaneous nerve is true? Tested Concept QID: 3919 Type & Select Correct Answer 1 Innervates the medial aspect of the proximal thigh 2% (74/3548) 2 Originates from the dorsal roots of L4-L5 22% (775/3548) 3 Course runs medial to the femoral artery 2% (62/3548) 4 Courses along the medial border of the psoas muscle 9% (330/3548) 5 Courses under the inguinal ligament 64% (2281/3548) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.180) The anterior Smith-Peterson approach to the hip uses a surgical plane between which of the following superficial muscles? Tested Concept QID: 3603 Type & Select Correct Answer 1 Gluteus maximus and tensor fascia lata 1% (19/2455) 2 Gluteus medius and tensor fascia lata 4% (88/2455) 3 Sartorious and adductor longus 2% (51/2455) 4 Rectus femoris and adductor longus 2% (48/2455) 5 Sartorious and tensor fascia lata 91% (2236/2455) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (OBQ09.103) What two nerves make up the internervous plane in the Smith-Petersen anterior hip approach? Tested Concept QID: 2916 Type & Select Correct Answer 1 There is no internervous plane 6% (155/2427) 2 Femoral nerve and inferior gluteal nerve 7% (162/2427) 3 Femoral nerve and superior gluteal nerve 84% (2044/2427) 4 Obturator nerve and superior gluteal nerve 2% (44/2427) 5 Obturator nerve and inferior gluteal nerve 0% (9/2427) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (OBQ07.263) The ascending branch of the lateral femoral circumflex artery is at risk with which of the following surgical approaches? Tested Concept QID: 924 Type & Select Correct Answer 1 Stoppa approach 2% (29/1533) 2 Kocher-Langenbach approach 10% (152/1533) 3 Ilioinguinal approach 5% (77/1533) 4 Watson-Jones approach 12% (190/1533) 5 Smith-Petersen approach 70% (1080/1533) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept
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