Common Orthopaedic Surgical Approaches

REGION

APPROACH

EPONYM

MUSCULAR INTERVAL 1

MUSCULAR INTERVAL 2

DANGERS

Shoulder

Anterior

Deltoid (axillary)

Pec Major (med / lat pec)

MC N/Axillary N/ceph V

Lateral

Deltoid (splitting) (axillary)

Deltoid (splitting) (axillary)

Axillary N

Posterior

Infraspinatus (Suprascap)

Teres minor (axillary)

Ax N / post cir hum A

Humerus

Anterolateral(Proximal)

Deltoid(Axillary)

Pec Mjr(med/lat pectoral)

Axillary N / ant cir hum A

Anterolateral(Distal)

Medial fibers Brachialis(MC)

Lat fibers Brachialis(Radial)

Radial Nerve

Posterior

Split heads of triceps (radial)

Radial N / Ulnar nerve

Elbow

Anterolateral(Prox)

Brachialis (Median)

Brachioradialis (Radial)

Lat ABC A / radial N
Radial Recurrent AV

Anterolateral(Distal)

Brachioradialis (Radial)

Pronator Teres (median)

Posterolateral

Kocher

Anconeus (radial)

Ext carpi ulnaris (PIN)

PIN (diss to ann lig)

Medial

Brachialis (musculocutaneous)

Triceps / pron teres
(radial / median)

Ulnar N

Forearm

Volar(Proximal)

Henry

Brachioradialis (radial)

Pron teres (median)

PIN

Volar(Distal)

Brachioradialis (radial)

FCR (Median)

Dorsal(Proximal)

Thompson

ECRB (radial)

EDC (PIN)

PIN

Dorsal(Distal)

ECRB (radial)

EPL (PIN)

Ulnar

ECU (PIN)

FCU (ulnar)

Ulnar N and A

Wrist

Dorsal

3^rd Compartment EPL (PIN)

4^th Compartmt EIP/EDC (PIN)

Radial N (superficial)

Scaphoid

Volar

Russe

FCR or through sheath (median)

Radial A

Radial A

Dorsolateral

Matti

1^st compartment (PIN)

3^rd compartment (PIN)

Sup rad N / radial A

Iliac Crest

Posterior

Gluteus maximus (inf gluteal)

Latissimus dorsi (thoracodorsal)

Clunial N, SGA, Sciatic N

Anterior

TFL / glut med & min(sup gluteal)

Ext abd oblique (segmental)

ASIS / LFCN

Thigh

Lateral

Vastus lateralis (femoral)

Vastus lateralis (femoral)

Perf br of profundus

Posterolateral

Vastus lateralis (femoral)

Hamstrings (sciatic)

Perf br of profundus

Anteromedial

Rectus femoris (femoral)

Vastus medialis (femoral)

Med sup geniculate A

Distal Femur

Posterior

Biceps Femoris (sciatic)

Vastus lateralis (femoral)

Sciatic N / PFCN

REGION

APPROACH

EPONYM

MUSCULAR INTERVAL 1

MUSCULAR INTERVAL 2

DANGERS

Hip

Anterior-      
       Superficial

Smith-Peterson

Sartorius(Femoral nerve)

TFL(Sup Gluteal Nerve)

LFCN, Fem N. asc br LFCA

Anterior -
       Deep

Smith-Peterson

Rectus femoris(femoral)

Gluteus medius (sup gluteal)

Same

Anterolateral

Watson-Jones

Tensor fasciae latae (sup gluteal)

Gluteus medius (sup gluteal)

Fem NAV / Profunda A

Lateral

Hardinge

Splits glut Med (sup gluteal)

Splits vastus lat (femoral)

Fem NAV / LF Circ artery

Posterior

Southern Moore

Splits glut Max (inf gluteal)

N/A

Sciatic N, inf glut A

Medial- Superficial

Ludloff

Add longus (Ant div obturator)

Gracilis (Ant div obturator)

Ant div obt N / MFCA

Medial- Deep

Ludloff

Add brevis (ant div obturator)

Add magnus(Obtur/Tibial)

Same

Knee

Med Parapatellar

Vastus medialis (femoral)

Rectus Femoris(Femoral)

Infrapatellar br saph Nerve

Medial

Vastus medialis (femoral)

Sartorius (femoral)

Infrapat br saph N, MCL

Lateral

Iliotibial band (sup gluteal)

Biceps femoris (sciatic)

Peroneal N / popliteus ten.

Posterior

Semimemb / Medial gastroc (tibial)

Biceps / lateral gastroc
(Tibial)

Med sural cut N / tib N / peroneal N

Tibia

Posterolateral

GS, soleus, FHL (tibial)

Peroneus brev/long(sup peron)

Lessser saph V / Post tib A

Anterior

Tibialis anterior (Deep peroneal)

Periosteum

Long saph V

Ankle

Anterior

EHL (deep peroneal)

EDL (deep peroneal)

Sup and Deep peroneal N / Ant tib Artery

Posteorlateral

Peroneus brevis (sup peroneal)

FHL (tibial)

Sural N / Short saph V

Posteromedial

FHL

Peroneals

Post Tib Artery/Nerve

Med Mall

Posterior

Tibialis posterior (tibial)

FDL (tibial)

Post Tib Artery/Nerve

Anterior

--------

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Saphenous N and V

Lat Mall

Lateral

Peroneus tertius (deep peroneal)

Peroneus brevis (sup peron)

Sural N, Sup Peron Nerve

Foot

Anterolateral

Peroneal muscles (sup peroneal)

EDC/per tertius (deep peron)

Deep per N / ant tib A

Posteromedial

Tibialis posterior or FDL (tibial)

FDL or FHL (tibial)

Post tib A / N