Introduction Indications open reduction of congenital hip dislocation psoas release (approach gives excellent exposure to psoas tendon) biopsy and treament of tumors of the inferior portion of the femoral neck and medial aspect of proximal femoral shaft obturator neurectomy Plane Superficial no superficial internervous plane as both the adductor longus and gracilis are innervated by the anterior division of the obturator nerve Deep internervous plane between adductor brevis and adductor magnus adductor brevis supplied by the anterior division of the obturator nerve adductor magnus has dual innervation adductor portion is supplied by the posterior division of the obturator nerve ischial portion by the tibial portion of the sciatic nerve Preparation Position patient is supine with the affected hip in a flexed, abducted, and externally rotated position Approach Incision longitudinal incision over the adductor longus begin incision 3 cm below the pubic tubercle length of incision is determined by the amount of femur that needs to be exposed Superficial dissection develop plane between gracilis and adductor longus muscles Deep dissection develop plane between adductor brevis and adductor magnus until you feel lesser trochanter on the floor of the wound protect posterior division of the obturator nerve isolate psoas tendon by placing narrow retractor above and below lesser trochanter Dangers Medial femoral circumflex artery passes around medial side of the distal part of the psoas tendon at risk in children when releasing psoas tendon must isolate psoas tendon and cut under direct vision Anterior division of obturator nerve supplies adductor longus, adductor brevis,and gracilis in the thigh Posterior division of obturator nerve lies within substance of oburator externus supplies adductor portion of adductor magnus Deep external pudendal artery at risk proximally lies anterior to pectineus near the origin of the adductor longus
QUESTIONS 1 of 2 1 2 Previous Next (OBQ09.16) Tenotomy of which muscle performed during an anteromedial approach for surgical reduction of a congenitally dislocated hip places the medial femoral circumflex artery at risk? Review Topic QID: 2829 1 semimembranosus 2% (20/1068) 2 biceps femoris 2% (18/1068) 3 iliopsoas 82% (879/1068) 4 rectus femoris 11% (119/1068) 5 sartorius 2% (24/1068) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 3 (OBQ08.18) Following an uneventful medial approach to the hip, the iliopsoas tendon is released. Which of the following neurovascular structures is most at risk during release of the tendon? Review Topic QID: 404 1 obturator nerve 17% (278/1681) 2 obturator artery 6% (99/1681) 3 femoral artery 13% (216/1681) 4 medial femoral circumflex artery 63% (1054/1681) 5 sciatic nerve 2% (27/1681) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 4