Clinical Videos: Approaches

All clinical videos focusing on approaches and surgical techniques are listed in this section.

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AO Video

Symphysis pubis approach through modified Pfannenstiel exposure

Mark Reilly and Stephen Sims perform the standard approach for symphysis disruptions, parasymphyseal fractures and medial superior pubic ramus fractures.

AO Video

Percutaneous iliosacral screw insertion: supine upper sacral segment

Stephen Sims performs a percutaneous iliosacral screw insertion. The percutaneous technique is used to insert a screw into the upper sacral segment from a supine position. Prior to undertaking this procedure, the surgeon must be familiar with the anatomy and osteology of the sacrum and its upper segment.

AO Video

The iliofemoral approach

Keith Mayo performs the iliofemoral approach which provides access to the iliac crest and the entire internal iliac fossa, as well as the anterior hip joint. The fossa exposure incorporates full visualization of the anterior aspect of the sacroiliac joint, if needed. This approach also provides digital and limited visual access to the quadrilateral surface and the greater sciatic notch.

AO Video

Heuter direct anterior approach to the hip joint

Stephen Sims performs an Heuter direct anterior approach to the hip joint which allows access through muscle planes, and does not incise or detach any muscle unless the direct head of the rectus femoris is sectioned to improve exposure. This approach allows direct visualization of the anterior hip capsule and the femoral head.

AO Video

Posterior midline approach to the sacrum

Mark Reilly performs the posterior midline approach to the sacrum. This is a more extensile approach to the sacrum than the conventional posterior approach and allows access to the whole sacrum if necessary. It will also allow for the implantation of lumbosacral fixation. This approach is generally chosen for the more complex sacral fractures, and in particular those that would require a decompression of neural elements by a dorsal laminectomy.

AO Video

Ilioinguinal approach-Letournel

Stephen Sims performs an ilioinguinal Approach–Letournel which allows visualization of the iliac crest and wing, from the sacroiliac joint, anteriorly to the hip joint. The superior pubic ramus is also exposed medially as far as the symphysis and the quadrilateral plate is visualized from the pelvic brim to the obturator foramen and lesser notch.

AO Video

Kocher–Langenbeck approach–lateral

David Stephen performs a Kocher Langenbeck approachwith the patrient in a lateral position which is a nonextensile approach to the posterior acetabulum. This approach allows direct visualization of the posterior column of the acetabulum, allows palpation of the quadrilateral plate, and the placement of reduction instruments onto the quadrilateral plate and external aspects of the posterior column. With transtectal fractures, gravity will displace the femoral head into the pelvis, making

AO Video

Posterior approach to the pelvic ring

Michael Stover performs the posterior approach to the pelvic ring. This approach to the posterior aspect of the pelvis provides access for treatment of posterior pelvic and sacral injuries. This approach allows access to the posterior iliac crest, the posterior aspect of the sacroiliac joint, and the sacrum lateral to the spinous processes on the side of the incision

AO Video

Kocher-Langenbeck approach–prone position

Stephen Sims performs a Kocher-Langenbeck approach with the patient in a prone position, which is a nonextensile approach to the posterior acetabulum. This approach allows direct visualization of the posterior column of the acetabulum, palpation of the quadrilateral plate, and the placement of reduction instruments onto the quadrilateral plate and external aspects of the posterior column. The prone position improves the visualization and palpation of the internal aspects of the column and

AO Video

Ilioinguinal approach–intrapelvic modification

Keith Mayo performs an Ilioinguinal approach with intrapelvic modification. The traditional ilioinguinal approach was developed by Letournel to provide access for fractures of the anterior aspect of the acetabulum. Based on the Stoppa approach, an intrapelvic modification has been developed which when combined with the ilioinguinal lateral window, provides another option for exposure of anterior acetabular fractures, and some selected both column and transverse fractures. This approach allows
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