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MEDICAL APPROACH TO THE HIP AND THE PROXIMAL THIGH

USES

In adults, this approach is used primarily for release of the adductor muscle. In children, it is used for adductor lengthening, for a partial obturator nerve neurectomy, or as an approach to the hip in congenital dislocation (in which case it is called the Ludloff approach).

ADVANTAGES

This approach provides direct access to the adductors. It also allows you to access the anterior and posterior branch of the obturator nerve, if you want to transect just a portion of the nerve.

DISADVANTAGES

This approach is of limited use in that it is difficult to see any structures deeper than the adductor muscles in an adult. Using it as an approach to the hip in an adult is very difficult, but in infants, because of the small size of their thigh and the looseness of the tissue, it is an approach that makes some sense.

STRUCTURES AT RISK

The most commonly injured structure with this approach is the obturator nerve or the artery. They run together and split into the anterior and posterior portions on either side of the adductor brevis muscle. As you proceed medially and approach the iliopsoas tendon, the medial femoral circumflex artery is at risk. It typically runs 1 cm proximal to the lesser trochanter.

Anteriorly, the pectineus muscle protects the femoral artery and nerve. If you are releasing the pectineus because it is also contracted, then those structures need to be protected.

TECHNIQUE

Related posts:

Volar Approach to the Basal Joint of the Thumb (for Bennett’s Fracture) Paronychium Approach Anterolateral Approach to the Tibia Deltopectoral Approach Posterior Approach Anterior Approach to the Cervical Spine

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