Orthopaedic MD

- Smith Petersen improved & revived the anterior iliofemoral approach;
- entire ilium and hip joint can be reached thru iliac part of incision;
- with this approach there is a need for extensive detachment of tendinous insertions & retraction of muscle, with potential damage to femoral artery and nerve and traction on lateral femoral cutaneous nerve;
- among the indications for this approach are ganz osteotomy for DDH and posterior hip frx dislocations;
Wheeless' Textbook of Orthopaedics

Discussion: - major problems with the Watson Jones technique are dealing w/ gluteus medius & minimus, which lie over anteior capsule and must be damaged or cut to obtain adequate exposure; - original Charnely technique used anterolateral approach w/ pt supine, osteotomy of greater troch, & ant dislocation of hip; - this approach is used less commonly now as result of problems related to reattachement of the greater trochanter;
Wheeless' Textbook of Orthopaedics

Notes on finger tip injuries and hand surgery approaches
Wheeless' Textbook of Orthopaedics

The anatomy of the hand is complex, intricate, and fascinating. Its integrity is absolutely essential for our everyday functional living. Our hands may be affected by many disorders, most commonly traumatic injury. For any physician or therapist treating hand problems, the mastery of such anatomy is fundamental in order to provide the best quality of care.
Synonyms and related keywords: hand innervation, hand bones, hand structure, hand anatomy, DIP joint, PIP joint, MCP joint, MCP, PIP, DIP, hand muscles, hand musculature, distal interphalangeal, proximal interphalangeal, metacarpophalangeal, finger joint, wrist joint, thumb joint, thenal complex, anatomy of the hand, bones of the hand, fascia of the hand, hand fascia, hand nerves, nerves of the hand, blood supply of the hand, hand blood supply, hand artery, hand vein
Marrero et al 2007

in direct lateral approach, a curvilear split is made thru the anterior portion of the gluteus medius and vastus muscles,in order to gain access to the anterior face of the hip joint;
- this approach allows a rather direct approach to the hip with minimal need for surgical assistants and affords excellent acetabular exposure;
Wheeless' Textbook of Orthopaedics

Disscussion:
- optimal age for the medial approach:
- is of more value in the child younger than 18 months but older than 7 months;
- when this procedure is used in infants younger than 7 months, there may be a higher risk of AVN, but some authors feel that the risk of AVN is increased in children older than 10 months of age;
Wheeless' Textbook of Orthopaedics

S shaped skin incision is made, extending along the posterior border of biceps and its tendon on the upper lateral side of popliteal fossa, then transversely across the fossa and finally along lower medial side of fossa posterior to semitendinosus tendon;
- skin flaps are retracted and the deep fascia is incised in midline;
- small saphenous vein is ligated if necessary but sural nerve must be preserved; etc.
Wheeless' Textbook of Orthopaedics

by R. CALANDRUCCIO In: Atlas of Orthopaedic Surgery Volume 3 Lower Extremity; Editors: Laurin, CA, Riley Jr. LH, Roy-Camille R
Surgical approaches to the hip may be classified as:
— anterior;
— anterolateral;
— lateral;
— posterior;
— medial;
— lateral subtrochanteric and proximal femoral shaft.

by M. HOHL In: Atlas of Orthopaedic Surgery Volume 3 Lower Extremity 1991
A surgeon should be familiar with several approaches to the knee region since each exposure has advantages and disadvantages. Adequate exposure, a minimum of retraction and intraoperative X-rays are important. Current techniques recommend early mobilization of the knee which means that soft tissue damage should be minimized, muscle splitting avoided wherever possible with accurate, strong repair of all tissues.

Stepwise illustrated account of Posterior or Posterolateral approach to the hip joint for joint replacement.
Wheeless' Textbook of Orthopaedics