Lateral Approach: Hardinge or Modified Hardinge Splits gluteus medius distal to superior gluteal nerve Surface markings: Longitudinal incision centred over GT and curving posteriorly Dangers: Superior gluteal nerve 4-5cm above tip of GT Waymarkers: Skin, subcutaneous tissues down to fascia lata Take GM off GT and go proximately laterally <4cm for access Extend incision inferiorly through VL Gluteus minimus is excised off anterior GT Expose anterior joint capsule and perform T shaped capsulotomy down to fibrous rim Important Notes: Leave sufficient cuff on bone to help reattach GM tendon Anterolateral Approach: Watson Jones Inter muscular plane Surface markings: 15cm incision centred over GT Dangers: Femoral vessels Waymarkers: Same approach as Modified Hardinge Find plane between GM and TFL (both superior gluteal nerve) Develop this interval and externally rotate hip to find origin of vastus lateralis Detach abductor mechanism In front of the joint capsule will lie rectus femoris and psoas which may need elevating and retracting
Lateral Approach: Hardinge or Modified Hardinge Splits gluteus medius distal to superior gluteal nerve Surface markings: Longitudinal incision centred over GT and curving posteriorly Dangers: Superior gluteal nerve 4-5cm above tip of GT Waymarkers: Skin, subcutaneous tissues down to fascia lata Take GM off GT and go proximately laterally <4cm for access Extend incision inferiorly through VL Gluteus minimus is excised off anterior GT Expose anterior joint capsule and perform T shaped capsulotomy down to fibrous rim Important Notes: Leave sufficient cuff on bone to help reattach GM tendon Anterolateral Approach: Watson Jones Inter muscular plane Surface markings: 15cm incision centred over GT Dangers: Femoral vessels Waymarkers: Same approach as Modified Hardinge Find plane between GM and TFL (both superior gluteal nerve) Develop this interval and externally rotate hip to find origin of vastus lateralis Detach abductor mechanism In front of the joint capsule will lie rectus femoris and psoas which may need elevating and retracting
Surgical-Approaches-in-Orthopaedics.docx