Authors of section

Author

Tomas Guerrero

Executive Editor

Amy Kapatkin

General Editor

Noel Moens

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Ventral approach

1. Indications

The ventral approach to the hip joint is a feasible alternative to treat epiphyseal and capital physeal fractures. This approach provides adequate visualization of the articular surface of the femoral head.

ventral approach

2. Anatomy

The pectineus muscle covers the hip joint ventrally. In a deeper plane, the medial circumflex femoral artery and vein run in a craniocaudal direction above the joint capsule. The femoral artery and vein and the saphenous nerve lie just cranial to the pectineus muscle.

Note: These vessels need to be identified and protected.

ventral approach

3. Skin incision

An incision of adequate length is made centered over the ventral acetabulum and pectineus muscle.

ventral approach

4. Exposure

The tendon of origin of the pectineus muscle is transected close to its attachment on the iliopectineal eminence.

ventral approach

The iliopsoas muscle is reflected distally, and the medial circumflex femoral vessels are gently retracted medially. This provides visualization to the joint capsule, which is incised in a plane parallel to the femoral neck.

ventral approach

5. Closure

The joint capsule is closed using absorbable sutures. The pectineus may be reattached using tension relieving suture pattern, or left unattached. Subcutaneous layer and skin are routinely closed.