OrthoNet

Acetabulum - anterior approach
(extended iliofemoral approach)

* position
- supine +/- sandbag under affected hip

* incision
- long icision following iliac crest to ASIS
- curve incision 8-15cm to run vertically down thigh towards lat. aspect of patella

* internervous plane
- sartorius (fem. n.) & TFL (sup. gluteal n.)
- rectus femoris (fem. n.) & gluteus medius (sup. gluteal n.)

* dissection
- ER leg to stretch sartorius
- ID gap btw TFL & sartorius usu 2-3 in below ASIS
- dissect down thru subcut. fat along intermuscular interval avoiding lat. fem. cut. n. –> pierces deep fascia of thigh close to interval
- incise deep fascia on med. side of TFL
- detach origin of TFL to develop plane
- ascending branch of lat. fem. circumflex art. crosses btw TFL & sartorius
- detach gluteus medius from origin with gluteus minimus
- for exposure of post. column, detach glutei from GT via osteotomy
- detach rectus from both origins (AIIS & sup. lip of acetabulum)
- to gain access to med. aspect of iliac wing, detach abd. musculature from iliac crest
- subperiosteal dissection under iliacus

* dangers
- lat. fem. cut. n.
> reches thigh by passing over, behind or thru sartorius 2.5 cm below ASIS
> beware of nerve when incising fascia btw TFL & sartorius

- femoral n. - lies directly ant. to hip joint in fem. triangle & well med. to rectus femoris

- ascending branch of lat. fem. circumflex art. - crossed field prox. btw TFL & sartorius

- superior gluteal art.
> form nv bundle that supplies gluteus min. & med.
> at risk with detachment of both origin & insertion of these 2 muscles