OrthoNet

Hip - medial approach
Ludloff

* position - supine with affected hip flexed, abducted & ER

* incision - long. incision on med. side of thigh starting 3 cm below pubic tubercle over add. longus

* internervous plane
- add. longus & gracilis (both innervated by ant. branch of obturator n. but receive nerve supply prox. to dissection)
- add. brevis & magnus
- add. magnus - 2 nerve supplies (post. division of obturator n. & tibial portion of sciatic n.)

* dissection
- incise subcut. tissue
- develop plane btw add. longus & gracilis
- develop plane btw add. brevis & magnus
- ID LT
- place retractor above & below LT to isolate psoas tendon

* dangers
- ant. div. of obturator n.
> lies on top of obturator ext. & runs down med. side of thigh btw add. longus & add. brevis
> supplies add. longus, gracilis, add. brevis

- post. div. of obturator n.
> lies in substance of obturator ext. & runs down thigh on add. magnus & under add. brevis
> supplies obturator ext. & add. portion of add. magnus

- med. fem. circumflex art. - passes around med. side of distal part of psoas