Uses
-Hemiarthroplasty
-THA, including revision
-ORIF post acetabulum
-Dependant drainage hip sepsis
-Removal loose bodies hip joint
-Pedicle bone grafting
-ORIF post. hip dislocations
Positioning
-Diving Board
-Peg Board
-True lateral
-Good padding
-Be certain you have room to move the hip
Landmark - greater troch
Incision - 10-15cm incision, curved, centered post aspect greater troch
Internervous plane - None
Superficial Dissection
-Incise fascia lata to uncover vast lateralis
-split glut max (may have some bleeding from branches sup./inf. gluteal art)
Deep Dissection
-Retract short external rotators (sup gamell, obt internus, inf gamell)
-Beware sciatic nerve, runs over SER
-Stay sutures in piriformis/obt internus tendons
-Beware quad femoris contains supply blood to hip
-Open capsule - hip exposed
-Dislocate with flexion, ext rotation and abduction
Dangers
-sciatic nerve - beware self retractors - may have two branches - beware of “small sciatic nerve”
-inf. gluteal artery - underneath piriformis = if lots bleeding, put pt. supine and tie off int. iliac artery
No comments:
Post a Comment