Hip and Pelvis

Chapter 6

Hip and Pelvis

David B. Weiss, Seth R. Yarboro, James A. Browne

Regional Anatomy and Surgical Intervals

Regional Anatomy


Pelvis (Figs. 6-1 and 6-2)


Extension of Nerves from the Lumbosacral Plexus (Fig. 6-14)

Branches of the sacral plexus

Sciatic nerve (L4 and L5 and S1, S2, and S3)

Exits the greater sciatic notch (GSN) and travels inferiorly, passing along the posterior aspect of the ischial tuberosity before passing into the posterior compartment of the thigh

The typical course is anterior to the piriformis and posterior to the superior/inferior gemellus, obturator internus, and quadratus femoris, but significant variation either through or around the piriformis can exist

Has tibial and peroneal divisions that are indistinguishable around the hip but later divide

The peroneal portion is more superficial and thus more prone to injury from posterior wall fracture and/or posterior hip dislocation or from retraction

Superior gluteal nerve (innervates the gluteus medius, gluteus minimus, and tensor fasciae latae muscles)

Exits the GSN and turns sharply superior to innervate the gluteus medius/minimus and tensor fasciae latae

A risk of injury exists with extensive superior and medial dissection above the GSN

Inferior gluteal nerve (innervates the gluteus maximus)

Exits the GSN inferior to the sciatic nerve and enters the gluteus maximus

Is at risk with extensive medial dissection around the posterior column near the GSN

Branches of the lumbar plexus

Lateral femoral cutaneous nerve

Exits the pelvis just medial to the ASIS (with wide variation up to 3 cm to either side)

Wide variation also exists with regard to the position of this nerve in relation to the sartorius muscle; it typically runs along the superficial lateral border, but it may run deeper or along the medial tensor fasciae latae (TFL)

Provides pure sensory innervation to anterolateral thigh

At risk with dissection or retraction during Smith-Petersen and direct anterior hip approaches and with ilioinguinal pelvic approaches

Obturator nerve

Innervates the adductors and travels inferior and lateral along the true pelvis below the pelvic brim and along the quadrilateral plate

Enters medial compartment of thigh as it penetrates superior aspect of obturator membrane in obturator foramen

Is at risk with exposure and retractor or hardware placement during ilioinguinal or Stoppa approaches

Femoral nerve (largest branch L2, L3, and L4)

Exits the pelvis over the anterior wall of the hip and lateral to the femoral artery and vein

Is at risk with anterior retractor placement during anterior and posterior approaches to the hip and during middle window dissection and retraction for ilioinguinal approaches

Anterior division—sensation to the anterior and medial thigh via the medial and intermediate cutaneous nerves of the thigh

Posterior division—quadriceps muscles and saphenous nerve

Vascularity (Fig. 6-15)

Internal Iliac Artery

Cross-Sectional Anatomy (Figs. 6-16 to 6-19)

Hazards (Figs. 6-20 and 6-21)

Femoral Triangle


Sciatic Nerve

Surgical Approaches to the Pelvis

Posterior Approach to the Sacroiliac Joint


Incision (Fig. 6-27)

Anterior Approach to the Pubic Symphysis (Video 6-1)image


Ilioinguinal Approach to the Pelvis (Video 6-2)image


Jun 7, 2016 | Posted by in ORTHOPEDIC | Comments Off on Hip and Pelvis
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