Hip – medial approach

* 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
– 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

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