How To Tell If You Are Lost

It is practically impossible to get lost with this approach because of the tibia, which is going to be on the medial side throughout the entire approach. It is possible to confuse the muscle belly of the anterior tibialis with the toe extensors and the peroneus tertius if you are drifting too far laterally. FIGURE 42 4 The dorsalis pedis artery and deep peroneal nerve. In this person they are running with the muscle, which had to be split to identify them. It is important to remember that, in...

Contents

1 Deltopectoral Approach 2 Posterior Approach 3 Deltoid Splitting Approach 4 Transacromial Approach 5 Superior Approach to the Suprascapular Nerve 6 Acromioclavicular Joint Approach 7 Anteromedial Approach 8 Lateral Approach to the Humerus 9 Posterior Approach to the Distal Humerus 10 Anterolateral Approach 11 Posterolateral Approach 12 Posterolateral Anconeus Approach 13 Posteromedial Approach to the Ulnar Nerve 14 Thompson Approach to the Proximal Radius 15 Anterolateral (Internervous)...

Technique

The patient is positioned prone with the arms tucked to the side. Adequate chest roll support is needed, but should be placed to allow the arm and scapula to fall free for the lateral parascapular approach. This can be accomplished by placing the chest roll more medially on the side of the scapula to be mobilized. As blood loss can be high, FIGURE 58 1 A hockey-stick incision is marked two to three levels above and two to three levels below the level of interest. It is extended laterally and...

How To Tell If You Are Losttricks

Spinous Process Removal

The incision should be marked directly over the spinous processes. Frequent palpation of the bony landmarks is typically all that is needed to ensure a midline approach. A midline raphe between the cervical musculature provides an excellent avascular plane for dissection. If the exposure seems excessively bloody with extensive muscle bleeding, stopping and identifying this midline plane will reduce further blood loss. The C2 spinous process is typically large and bifid. The C3 process is often...

Info

Midpalmar Space

FIGURE 22-3 The flexor tendons to the index finger are exposed. The laterally lying fat encases the radial digital nerve to the index finger. FIGURE 22-4 The midpalmar space is exposed through the interval between the common digital neurovascular bundle and the flexor tendons. B Superficial and Deep Flexor Tendons to Index D Adductor Pollicis D Flexor Tendons and Lumbrical to Index Q Radial Digital Nerve to Index Case 22 Approach to the Lateral Thenar Midpalmar Space 83 FIGURE 22-5 The interval...

Tricks

When incorporating traumatic wounds into this incision, a more acute angle may be necessary. If you are unable to create a zigzag pattern without creating a skin angle more acute than 60 degrees, then make a longitudinal extension of the traumatic wound to the level of the skin crease, and extend the incision diagonally across the crease. When raising flaps, use the scissors to bluntly dissect, by spreading in a longitudinal direction. This reduces the chance of injury to the digital nerve and...

Structures At Risk

Laterally, the structure at risk is the radial nerve. This nerve enters the forearm underneath the brachioradialis muscle, which is the first muscle identified with this approach. The anterior edge of that muscle should be dissected and the nerve will be found on the inner border of the muscle. It should be retracted out of the way and protected. The brachial artery and the median nerve are at risk if you are dissecting medial to the biceps tendon. As long as you stay lateral to those tendons,...

Atlas of Orthopaedic Surgical Exposures

Downey Mental Hospital Rancho Los Amigos

Atlas of Orthopaedic Surgical Exposures Director of the Surgical Anatomy Lab Rancho Los Amigos National Rehabilitation Center Downey, California Research Associate NYU-Hospital for Joint Diseases New York, New York Thieme New York 333 Seventh Avenue New York, NY 10001 Developmental Manager Kathleen P. Lyons Director, Production and Manufacturing Anne Vinnicombe Chief Financial Officer Seth S. Fishman Library of Congress Cataloging-in-Publication Data is available from the publisher. Copyright...