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Hip: dorsal approach

ISSN 2398-2950

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Synonym(s): Trochanteric osteotomy

Introduction

  • To access the hip joint using trochanteric osteotomy.

Uses

Advantages

  • Provides complete exposure of hip region.

Alternative techniques

  • Craniolateral approach to hip Hip: craniolateral approach - gives good exposure for many procedures.
  • Caudolateral approach to hip Hip: caudolateral approach - used for open reduction of craniodorsal luxations (rarely required) and some acetabular fixations.
  • Hemipelvis approach to hip - useful for open reduction and internal fixation of multiple pelvic fractures that have acetabular component.
  • Ventral approach to hip - provides limited exposure to joint - adequate for femoral head and neck surgery only.

Requirements

Materials required

Minimum equipment

Preparation

Site preparation

Major landmarks

Preparation

  • Standard aseptic (clip, clean, scrub and drape) .

Restraint

Technique

Approach

Step 1 - Skin incision

  • Skin incision centered over greater trochanter.
  • The line of the skin incision runs just cranial to the femur, starting one third of the length of the bone from the greater trochanter and running proximally just cranial to the trochanter, and then angling caudally by 30° to a point midway between the trochanter and the animal's dorsal midline.
  • Undermine and retract skin.

Step 2 - Subcutaneous incision

  • Identify fascia of superficial gluteal muscle and tensor fascia lata and dissect in a curvilinear direction from just proximocranial to greater trochanter ventrally.

Step 3 - Dissection

  • Retract biceps femoris caudally.
    Care to avoivd sciatic nerve.
  • Elevation, or partial tenotomy, of superficial gluteal muscle.
  • Retract superficial gluteal muscle craniodorsally.
  • Osteotomize greater trochanter with osteotome or Gigli wire saw at an angle of 45° with long axis of femur (to cut the trochanter flush with femoral neck). 
  • Perform tenotomy of internal obturator and gemelli muscles. Retract middle and deep gluteal muscles dorsomedially as a unit with the greater trochanter.
    Take care to protect sciatic nerve.

Step 4 - Arthrotomy

  • Incise joint capsule to enter joint.

Core procedure

Step 1 - Primary procedure

  • Further dissection depends upon primary procedure. Care is taken to protect the sciatic nerve and caudal gluteal neurovascular bundle.

Exit

Step 1 - Closure of joint capsule

  • Close joint capsule using standard materials and methods.

Step 2 - Closure of fascia

  • Repair osteotomy with lag screw or pins and a figure-of-eight tension band wire anchored to a femoral diaphyseal caudal cortical tunnel.
  • Repair sectioned tendons and muscles using routine methods and materials.
  • Close fascia using routine materials and methods.

Step 3 - Skin closure

  • Routine skin closure.

Aftercare

Outcomes

Further Reading

Publications

Refereed papers