List four dangers of the Stoppa approach
Corona Mortis (lateral 1/3 sup. pubic ramus)
Bladder (insert foley)
Obturator nerve and vessels (when exposing quad plate)
External iliac vessels (mobilize early)
What is the potential space of retzius ?
Anterior to bladder post to pubic symphisis
What muscle do you have to take down to see quadrilateral plate?
What fascia separates the middle and lateral window of the ilioinguinal approach?
List five contents of the Greater sciatic notch
superior and inferior gluteal vessels and nerves
sciatic and posterior femoral cutaneous nerves
internal pudendal vessels
nerves to the obturator internus and quadratus femoris
List the structures that separate the windows in the ilioinguinal approach
Lateral: Iliac wing to Iliopsoas and femoral nerve
Middle: psoas to External iliac vessels
Medial: External iliac vesselst to rectus abdominus
What are the Denis zones of the sacrum?
1: lateral to foramen
3: medial to foramina into spinal canal
What nerve root runs along the sacral ala?
What is the sacral ala?
Top of sacrum forming iliosacral triangle
What is the importance of iliac cortical density?
On the lateral this parallels the alar slope, you want to be below this when inserting an SI screw
On an AP pelvis is the posterior wall lateral or anterior?
Judet views describe
Obturator oblique - AC (iliopectineal line), PW
Iliac oblique - AW, PC (ilioischial line)
What is a morale lavale lesion?
Internal degloving of subcutaneous tissue off of the lumbosacral fascia
What are key SI ligaments? What are the other three important ones?
Anterior, Posterior, Interosseous Sacrotuberous, Sacrospinous, Iliolumbar ligament
Name the Contents of the Sciatic Notch Relative to Piriformis
Contents of GSN
Superior Gluteal Nerve & Artery
Pudendal nerve and internal pudendal artery
Nerve to obturator internus
Posterior femoral cutaneous nerve
Inferior gluteal artery and nerve
Nerve to quadratus femoris
What travels through LSN?
Obturator internus muscle
Nerve to obturator internus
Internal pudendal vein
What is the cruciate anastomosis made of?
First perforator of profunda
Inferior gluteal artery
The cruciate anastomosis is clinically relevant because if there is a blockage between the femoral artery and external iliac artery, blood can reach the popliteal artery by means of the anastomosis. The route of blood is:
Internal iliac --> inferior gluteal artery --> a perforating branch of the deep femoral artery --> lateral circumflex femoral artery --> its descending branch --> superior lateral genicular artery --> popliteal artery.
Nerves relative to psoas Lateral (3) Medial (2) Between iliac and psoas 1 Piercing than anterior
Lateral - iliohypogastric, lioinguinal, LFCN
Medial - obturator, lumbosacral trunk
Between - femoral
Piercing - genitofemoral
What nerve is at risk with a retractor under transverse acetabular ligament?
How can we adduct after an obturator neurectomy
What nerve is above piriformis?
Superior gluteal nerve
What structure is most at risk of posterior ICBG harvest?
Superior gluteal artery, to a lesser extent cluneal nerves
Between What muscles does the posterior obturator nerve run between?
Adductor brevis and magnus
In the anterior Smith-Peterson approach the deep interval is between?
Rectus femoris and Gluteus medius
Name the ligaments connecting the pubic sympysis
Superior pubic ligament (stronger)
Inferior (arcuate) public ligament
What type of joint is the pubic symphysis?
Synovial amphiarthroidal joint
What do the medial sacral crest and alae of the sacrum represent embryologically?
Medial sacral crest: fused spinous processes
Alae and SI articular processes: fused TP and costal processes
What strucures are near the posterior sacral foramina?
Dorsal primary rami
What structures are near the anterior sacral foramina?
Ventral primary rami
In which direction are the coccyx of men and women directed?
Men: anteriorly towards pubis (like a penis)