How To Tell If You Are Lost

Unlock Your Hip Flexors

Unlock Your Hip Flexors

Get Instant Access

It is easy to get confused as to which muscle is which with this approach because of the muscles' very large size and because they all tend to run together, especially proximally. If you are not seeing the adductor longus and brevis discretely with the anterior branch of the obturator nerve, then you are probably lost. Usually you would be lost anteriorly, which is a very dangerous situation, because if you are anterior to the pectineus the femoral neurovascular structures are very much at risk.

If you are lost posteriorly, you will see the fibers of the gracilis, which are running longitudinally down the leg. The key clue here is the thinness of this muscle in a medial and lateral direction; the width of the muscle runs from anterior to posterior rather than medial to lateral, like the other adductors.

Adductor Longus Muscle
FIGURE 32-2 The adductor longus tendon. The gracilis, which is in an inferior position, is still covered by fat and is not visible. Note the large size of the adductor longus.

FIGURE 32-1 The skin incision, which starts right at the most proximal portion of the leg directly over the adductor longus tendon.

Adductor Longus

FIGURE 32—4 The gracilis muscle with the fat removed. The gracilis is a very wide muscle running in an anterior and posterior direction, but is very thin, medial to lateral.

FIGURE 32—3 The fascia over the adductor longus tendon split, exposing the tendon more completely.

FIGURE 32—4 The gracilis muscle with the fat removed. The gracilis is a very wide muscle running in an anterior and posterior direction, but is very thin, medial to lateral.

case 32 medial approach to the hip and the proximal thigh • 115

Obturator Nerve Pectineus
FIGURE 32—5 The adductor longus and gracilis pulled in a posterior direction exposing the adductor brevis tendon. Note the neurovascular bundle of the anterior branch of the obturator nerve and artery on the anterior aspect of the muscle.

FIGURE 32—6 All of the adductors retracted in a posterior direction. The Bennett retractor is sitting underneath the lesser trochanter. You can see the iliacus muscle and psoas tendon, and notice the very large medial femoral circumflex artery, which usually crosses within 1 cm of the lesser trochanter.

H Adductor Longus

El Gracilis

E3i Adductor Brevis

E! Obturator Nerve

B Iliacus Muscle and Psoas Tendon B Medial Femoral Circumflex Artery B Adductor Muscles

posterolateral (gibson) approach

Was this article helpful?

0 0

Post a comment