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Operative Approaches Workbench - 148+ Surgical approaches

Comprehensive surgical approach guides for advanced orthopaedic practice. Each approach covers positioning and landmarks, the internervous plane, the dissection step by step, structures at risk, and how it compares with alternative approaches.

Arthroplasty — 16 approaches

adult-reconstruction (16 approaches)

  • Anteromedial Approach to the Knee - How to expose the knee through the anteromedial (medial parapatellar) approach — the standard arthrotomy for total knee arthroplasty, the dissection sequence from skin to patellar eversion, the subvastus and midvastus variations, the structures at risk (saphenous nerve, infrapatellar branch, patellar tendon) and the extensile options. advanced orthopaedic operative-surgery guide.
  • Direct Anterior Approach to the Hip (Hueter Interval) - Comprehensive guide to the direct anterior approach (Hueter interval) to the hip - supine positioning, the internervous plane between sartorius/rectus femoris and tensor fasciae latae, lateral femoral cutaneous nerve protection, ascending branch of the lateral circumflex femoral artery, anterior capsulotomy, femoral exposure and releases, and closure for Orthopaedic exam
  • Ganz Trochanteric Flip Approach to the Hip - Comprehensive guide to the Ganz surgical hip dislocation via trochanteric flip osteotomy - safe access to femoral head and acetabulum, MFCA preservation, Z-capsulotomy for FAI, head fractures and acetabular rim work - for Orthopaedic exams
  • Gibson Approach to the Hip (Abductor-Sparing Posterior) - Comprehensive guide to the Gibson posterolateral approach to the hip - lateral decubitus, the internervous plane between gluteus maximus and gluteus medius that spares the abductors and the inferior gluteal nerve, reflection of the short external rotators, sciatic nerve protection, and posterior hip access
  • Hip Direct Lateral Approach (Hardinge) - Comprehensive guide to the Hardinge direct lateral approach to the hip - indications, technique, internervous plane, structures at risk, and surgical pearls for Orthopaedic exam
  • Hip Medial Approach (Ludloff) - Comprehensive guide to the medial approach to the hip - Ludloff approach, adductor interval, obturator neurovascular structures, and applications in DDH and hip surgery for Orthopaedic exam
  • Hip Posterior Approach (Moore/Southern) - Comprehensive guide to the posterior (Moore/Southern) approach to the hip - true internervous plane, piriformis preservation, capsular repair, and dislocation prevention for Orthopaedic exam
  • Medial Parapatellar Approach to Knee - Comprehensive guide to the medial parapatellar approach to the knee for total knee arthroplasty, extensile exposure, and extensor lag prevention
  • Midvastus Approach to Knee - Limited muscle-splitting TKA approach dividing distal VMO fibers longitudinally, balancing muscle preservation with adequate exposure
  • Posterolateral Approach to Knee (Fibular Head) - Comprehensive guide to the posterolateral approach to the knee for LCL reconstruction, posterolateral corner repair, and fibular head procedures
  • Quadriceps Snip and V-Y Turndown for Extensile Knee Exposure - Extensile proximal exposure of the stiff and ankylosed knee for revision TKA - the rectus/quadriceps snip and the Coonse-Adams V-Y quadricepsplasty turndown, including the trans-tendinous anatomy, patellar blood supply, contrast with tibial tubercle osteotomy, repair and rehabilitation
  • Subvastus Approach to Knee - How to expose the knee for total knee arthroplasty through the subvastus (Southern) approach — the muscle-sparing arthrotomy that passes UNDER vastus medialis obliquus, elevating it subperiosteally off the medial tibia without cutting muscle fibres, preserving the VMO and its nerve supply from the descending genicular pedicle. advanced orthopaedic operative-surgery guide.
  • SuperPath / Superior-Capsulotomy Approach to the Hip - Comprehensive guide to the SuperPath / SuperCap tissue-sparing posterior approach to the hip for total hip arthroplasty - lateral decubitus positioning, the gluteus minimus-piriformis interval, in-situ femoral broaching with capsule and external rotators preserved, and superior gluteal nerve protection for the Orthopaedic exam
  • Tibial Tubercle Osteotomy for Extensile Knee Exposure - Extensile exposure of the stiff or revision knee by a long, lateralised tibial tubercle osteotomy carrying a proximal step cut and a lateral periosteal hinge, with lateral eversion of the extensor mechanism and rigid screw refixation - indications, internervous plane, danger structures, fixation and closure for the Orthopaedic exam
  • Trochanteric Osteotomy Approaches to the Hip (Standard, Extended, Slide) - Comprehensive guide to the trochanteric osteotomy family of hip exposures for advanced orthopaedic practice - the standard osteotomy, the trochanteric slide with abductor-vastus lateralis continuity, and the extended trochanteric osteotomy (ETO) for femoral component and cement removal in revision THA, with fixation, superior gluteal nerve protection, and closure.
  • Two-Incision Minimally Invasive Approach to the Hip - Comprehensive guide to the two-incision minimally invasive total hip arthroplasty approach - the anterior Hueter and Smith-Petersen interval for the acetabulum, a separate posterolateral stab incision for femoral preparation under fluoroscopy, internervous planes, lateral femoral cutaneous and sciatic nerve dangers, and why the technique has fallen out of favour - for orthopaedic exam preparation

Trauma — 47 approaches

trauma (47 approaches)

  • Anterior Approach to Humeral Shaft (Henry) - Comprehensive guide to the anterior (Henry) approach to the humeral shaft for ORIF of mid/distal humerus fractures with emphasis on radial nerve protection
  • Anterior Approach to Sacroiliac Joint - Comprehensive surgical technique guide for the anterior approach to the sacroiliac joint - used for SI screw fixation, ORIF of anterior pelvic ring injuries, and revision SI arthrodesis.
  • Anterolateral (Anterior, Brachialis-Splitting) Approach to the Humerus - How to expose the humeral shaft through the anterolateral (anterior) approach and its brachialis-splitting distal extension — the deltopectoral-derived proximal interval, developing lateral to biceps with the musculocutaneous nerve protected, the brachialis-splitting dissection (dual innervation: musculocutaneous medially, radial laterally), the anterior MIPO windows, and radial-nerve protection for plating of proximal-to-distal-third diaphyseal fractures. advanced orthopaedic operative-surgery guide.
  • Anterolateral / Direct Lateral Approach to the Distal Tibia (Pilon) - How to expose the anterolateral distal tibia for pilon fractures through the direct lateral (anterolateral) approach — supine positioning, the fourth-ray incision, superficial peroneal nerve protection, the internervous plane lateral to tibialis anterior, subperiosteal medial elevation of the extensor compartment and anterior neurovascular bundle, and direct access to the anterolateral plafond and Chaput fragment. advanced orthopaedic operative-surgery guide.
  • Anterolateral Approach to Radius (Henry) - Comprehensive guide to the Henry anterolateral (volar) approach to the radius for ORIF of radial shaft fractures and forearm pathology — internervous planes, radial artery management, PIN and superficial radial nerve protection, and outcomes. advanced orthopaedic operative-surgery guide.
  • Anterolateral Approach to the Distal Humerus - Comprehensive guide to the anterolateral approach to the distal third of the humerus for extra-articular distal shaft fractures, including the brachialis-brachioradialis interval, mandatory identification of the radial nerve as it pierces the lateral intermuscular septum, anterior plating, and how it compares with the posterior and combined bimodal approaches.
  • Anterolateral Approach to the Femoral Shaft - Comprehensive operative guide to the anterolateral approach to the femoral shaft for plating, bone grafting and nonunion surgery - lateral thigh landmarks, fascia lata splitting, vastus lateralis elevation, perforating vessel ligation, femoral neurovascular protection, extensile options and closure for Orthopaedic exams
  • Anterolateral Approach to the Proximal Tibia (Lateral Tibial Plateau) - Comprehensive guide to the anterolateral approach to the proximal tibia and lateral tibial plateau for ORIF of lateral plateau fractures - supine positioning, Gerdy tubercle landmarks, anterior compartment elevation, submeniscal arthrotomy, CPN and anterior tibial vessel dangers, and buttress plating for Orthopaedic exam
  • Anteromedial Approach to the Tibial Shaft - Comprehensive guide to the anteromedial approach to the tibial shaft - supine positioning, saphenous nerve protection, direct subperiosteal medial exposure, wound healing considerations, and indications for plating, grafting and osteotomy for Orthopaedic exams
  • Approach to the Clavicle (Superior and Anteroinferior) - Comprehensive guide to the surgical approaches to the clavicular shaft for contemporary practice - beach chair positioning, superior versus anteroinferior incisions and plate-position trade-offs, platysma and supraclavicular nerve protection, the internervous plane, danger structures including the subclavian vessels and pleura, extensile options and closure for Orthopaedic exam
  • Approach to the Fibula (Lateral, Peroneal-Protecting) - Comprehensive guide to the lateral approach to the fibular shaft - peroneal-protecting technique, superficial peroneal nerve identification in distal third, subperiosteal exposure, indications for fibular plating, bone graft harvest and osteotomy for Orthopaedic exams
  • Approach to the Proximal Fibula and Common Peroneal Nerve - Comprehensive operative guide to the surgical approach to the proximal fibula and common peroneal nerve - lazy-S incision, mandatory CPN identification and protection, subperiosteal dissection, PLC reconstruction, fibular head procedures, and decompression for Orthopaedic exams
  • Approach to the Ulnar Shaft (Subcutaneous Border) - How to expose the ulnar shaft through the direct subcutaneous-border approach — the true FCU–ECU internervous plane (ulnar nerve versus posterior interosseous nerve), protection of the volar ulnar neurovascular bundle and the dorsal ulnar cutaneous nerve, and the evidence on bracing versus fixation. advanced orthopaedic operative-surgery guide.
  • Combined Anteromedial and Anterolateral Approaches to the Pilon - Comprehensive guide to the combined anteromedial and anterolateral approaches to the distal tibia for complex pilon fractures - staged spanning external fixation, the anteromedial Ruedi-Allgower incision protecting the saphenous nerve and long saphenous vein, the anterolateral fourth-ray incision protecting the superficial peroneal nerve, the intervening skin bridge, and access to the medial, central and Chaput fragments for Orthopaedic exam
  • Combined Two-Incision Approach for Both-Bone Forearm Fractures - Surgical approach guide to ORIF of both-bone (radius and ulna) diaphyseal forearm fractures through two separate incisions - the volar Henry or dorsal Thompson approach to the radius and the direct dorsoulnar approach to the subcutaneous ulna - covering internervous planes, danger structures, radial-bow restoration, synostosis prevention and closure for the Orthopaedic exam
  • Dorsal Approach to Midfoot - Comprehensive guide to dorsal approaches to the midfoot for Lisfranc injuries, tarsometatarsal arthrodesis, midfoot fractures, and Charcot reconstruction, including multiple longitudinal incisions, deep peroneal nerve protection, and compartment-specific access to medial, middle, and lateral columns.
  • Dual-Incision Approach to the Bicondylar Tibial Plateau - Comprehensive guide to the combined anterolateral plus posteromedial dual-incision approach for bicondylar (Schatzker V and VI) tibial plateau fractures - maintaining an adequate skin bridge, column-specific reduction sequencing, danger structures by layer, and dual plating for contemporary practice orthopaedic exams
  • Extended Iliofemoral Approach to the Acetabulum - Comprehensive guide to the extended iliofemoral approach for complex acetabular fractures - single-incision access to anterior and posterior columns, technique, and exam preparation
  • Femur - Anteromedial Approach - Surgical approach to the medial and anterior aspects of the femoral shaft through an internervous interval, used for fracture fixation, tumor excision, and reconstruction
  • Hip Anterior Approach (Smith-Petersen) - Comprehensive guide to the anterior approach to the hip (Smith-Petersen) - indications, internervous plane, step-by-step technique, structures at risk, and surgical decision-making for orthopaedic fellowship exam
  • Hip Anterolateral Approach (Watson-Jones) - Comprehensive guide to the anterolateral approach to the hip (Watson-Jones) - indications, internervous plane, step-by-step technique, structures at risk, and surgical decision-making for orthopaedic fellowship exam
  • Iliac (Lateral Window) Approach to the Pelvis - Gold-standard operative guide to the iliac (lateral window) approach for iliac wing fractures, high anterior column acetabular fractures, and SI joint access - supine or lateral positioning, LFCN protection, subperiosteal dissection of iliacus, and pelvic brim exposure for Orthopaedic exams
  • Ilioinguinal Approach to the Acetabulum - Comprehensive guide to the ilioinguinal approach for anterior column and anterior wall acetabular fractures - surgical anatomy, technique, and exam preparation
  • Kocher-Langenbeck Approach to the Acetabulum - Comprehensive guide to the Kocher-Langenbeck posterior approach for posterior wall and posterior column acetabular fractures - surgical anatomy, sciatic nerve protection, and exam preparation
  • Lateral Approach to the Distal Humeral Shaft - Comprehensive guide to the lateral approach to the distal third of the humeral shaft and lateral column - supine positioning, the lateral supracondylar ridge incision, the true internervous plane between brachialis and triceps or brachioradialis, identification and protection of the radial nerve as it pierces the lateral intermuscular septum, distal-third plating, bridging the radial nerve, and extensile distal extension to the capitellum for Orthopaedic exam
  • Lateral Approach to the Femoral Shaft (Vastus Lateralis) - Comprehensive guide to the lateral approach to the femoral shaft - supine positioning, fascia lata incision, anterior elevation of vastus lateralis off the lateral intermuscular septum, ligation of the perforating branches of the profunda femoris, and subperiosteal access to the linea aspera for shaft and distal femoral plating - for the Orthopaedic exam
  • Lateral Approach to the Fibula and Lateral Malleolus - Comprehensive guide to the direct lateral approach to the fibula and lateral malleolus for ankle fracture ORIF - supine positioning, superficial peroneal nerve and sural nerve protection, posterolateral antiglide plating, syndesmotic assessment, and closure for Orthopaedic exam
  • Lateral Extensile Approach to Calcaneus - The lateral extensile (extended lateral, Benirschke-Sangeorzan) approach to the calcaneus for displaced intra-articular calcaneal fractures — the L-shaped full-thickness flap, lateral calcaneal artery perfusion, sural nerve management, wrinkle-sign timing, posterior-facet reduction and wound-complication avoidance. advanced orthopaedic operative-surgery guide.
  • Lateral Parapatellar Approach to Knee - Specialized surgical approach for lateral tibial plateau fractures, lateral compartment pathology, and revision TKA with valgus deformity
  • Medial Approach to the Arm and Distal Humerus - Comprehensive operative guide to the medial approach to the arm (brachium) and distal humerus along the medial intermuscular septum - supine positioning, the true brachialis-triceps internervous plane, protection of the brachial artery, median nerve, ulnar nerve, basilic vein and medial antebrachial cutaneous nerve, vascular and nerve exploration, and limited fracture fixation for Orthopaedic exams
  • Medial Approach to the Femur - Comprehensive guide to the medial approach to the femoral shaft - the femoral/obturator internervous plane between vastus medialis and the adductors, the danger of the femoral vessels in the adductor (subsartorial/Hunter's) canal, the saphenous nerve and perforating branches of the profunda femoris, indications of vascular access and medial bone grafting, and closure - for the Orthopaedic Operative Surgery exam
  • MIPO Anterior Humeral Corridor - Comprehensive guide to minimally invasive plate osteosynthesis (MIPO) via the anterior humeral corridor for bridge plating of humeral shaft fractures - supine positioning, deltopectoral and anterolateral windows, the brachialis protecting the radial nerve, and submuscular plate tunnelling for Orthopaedic exam
  • Modified Stoppa Approach to the Acetabulum - How to expose the quadrilateral surface and medial acetabular wall through the modified Stoppa (anterior intrapelvic) approach — the midline incision, developing the space of Retzius, mobilising the bladder, ligating the corona mortis, and applying a quadrilateral buttress plate. advanced orthopaedic operative-surgery guide.
  • Pfannenstiel Approach to the Pubic Symphysis - Comprehensive guide to the Pfannenstiel (modified Stoppa) approach to the pubic symphysis and superior pubic rami for symphyseal plating and anterior pelvic ring fixation - transverse suprapubic incision, rectus management, bladder protection, corona mortis identification, and closure for Orthopaedic exam
  • Posterior Approach to Humerus - Comprehensive guide to the posterior approach to the humerus for mid-shaft fracture fixation and radial nerve exploration, including radial nerve anatomy in the spiral groove, triceps management techniques, and approach extensibility for entire humeral shaft access.
  • Posterior Approach to Sacroiliac Joint - Comprehensive surgical approach to sacroiliac joint disruption, providing direct access for plate fixation with clear neurovascular landmarks
  • Posterior Approach to the Distal Femur and Popliteal Fossa - How to expose the posterior distal femur and popliteal fossa through the prone, lazy-S posterior approach — the gastrocnemius-head interval, identifying the medial sural cutaneous nerve to reach the tibial nerve, protecting the common peroneal nerve and popliteal vessels, and indications for Hoffa fragments and PCL avulsions. advanced orthopaedic operative-surgery guide.
  • Posterior Approach to the Distal Tibia (Posterior Malleolus) - Comprehensive guide to the posterior approaches to the distal tibia and posterior malleolus for pilon and trimalleolar fractures - prone positioning, posterolateral and posteromedial intervals, posterior tibial neurovascular bundle protection, and buttress fixation for Orthopaedic exams
  • Posterior Approach to the Knee (Popliteal Fossa) - How to expose the central posterior knee through the popliteal fossa - prone positioning, the lazy-S incision across the flexion crease, the sural nerve and short saphenous vein superficially, the interval between the heads of gastrocnemius, and the popliteal neurovascular bundle order. advanced orthopaedic operative-surgery guide.
  • Posterior Triceps-Sparing (Paratricipital) Approach to the Humerus - Comprehensive guide to the posterior paratricipital (Alonso-Llames) triceps-sparing approach to the distal humerus and elbow - lateral or prone positioning, medial and lateral triceps windows, radial and ulnar nerve protection, and indications for Orthopaedic exam
  • Posterolateral Approach to the Femur - Gold-standard guide to the posterolateral approach to the femoral shaft for advanced orthopaedic practice - internervous plane, perforator ligation, sciatic nerve relations, and extensile exposure for shaft plating and nonunion surgery
  • Posteromedial Approach to Knee - Posterior medial knee exposure for posteromedial tibial plateau fractures, posteromedial corner injuries, and posterior medial meniscus pathology
  • Posteromedial Approach to the Tibial Plateau - How to expose the posteromedial tibial plateau — prone positioning, protecting the saphenous nerve and greater saphenous vein, the internervous plane between the pes anserinus and medial gastrocnemius, popliteal bundle safety, and buttress plating of posterior coronal split fragments. advanced orthopaedic operative-surgery guide.
  • Sinus Tarsi Approach to Calcaneus - How to expose the calcaneus through the minimally invasive sinus tarsi approach for displaced intra-articular calcaneal fractures — the oblique sinus tarsi incision, protecting the intermediate dorsal cutaneous nerve, EDB retraction, indirect reduction (Essex-Lopresti maneuver, plantar bone tamp) and fluoroscopy-guided fixation. advanced orthopaedic operative-surgery guide.
  • Smith-Petersen / Iliofemoral Extensile Approach to the Acetabulum and Anterior Column - Gold-standard guide to the Smith-Petersen / iliofemoral extensile approach to the acetabulum and anterior column - supine positioning, the sartorius-TFL and rectus femoris-gluteus medius internervous planes, the lateral femoral cutaneous nerve and superior gluteal bundle danger, subperiosteal inner and outer iliac table exposure, procedures, and closure for the advanced orthopaedic practice Orthopaedic exam
  • Tibia Posterolateral Approach - How to expose the posterolateral tibial plateau through the Frosch posterolateral approach — prone positioning, fibular head landmarks, common peroneal nerve protection, the peroneus longus / soleus interval, and posterior buttress plating. advanced orthopaedic operative-surgery guide.
  • Triradiate Extensile Approach to the Acetabulum - Comprehensive guide to the triradiate (Y) extensile approach to the acetabulum for complex both-column acetabular fractures - lateral positioning, trochanteric osteotomy to reflect the abductors, simultaneous two-column access, the superior gluteal neurovascular bundle and sciatic nerve as dangers, and the high complication burden for Orthopaedic exam

Spine — 24 approaches

spine (24 approaches)

  • Anterior Retroperitoneal Approach to Lumbar Spine - How to expose the L4-5 and L5-S1 disc spaces through an anterior retroperitoneal (ALIF) approach — the abdominal-wall split, mobilising the great vessels, the left common iliac vein and ascending lumbar vein at L5-S1, protecting the superior hypogastric plexus, and preventing retrograde ejaculation. advanced orthopaedic operative-surgery guide.
  • Anterior Retropharyngeal Approach to the Upper Cervical Spine (C1–C3) - Comprehensive guide to the anterior retropharyngeal approach (Robinson–Southwick / McAfee) to the upper cervical spine and craniovertebral junction - supine positioning, marginal mandibular nerve protection, internervous plane medial to carotid sheath, and extraoral access for odontoid and C1–C3 pathology
  • Anterior Thoracolumbar Junction Approach (Thoracoabdominal) - Comprehensive guide to the anterior thoracoabdominal approach to the T10-L2 thoracolumbar junction - lateral decubitus positioning, rib resection, circumferential diaphragm takedown with a peripheral cuff, the retroperitoneal plane, and protection of the artery of Adamkiewicz and great vessels for Orthopaedic exam
  • Anterior Transperitoneal Approach to L5–S1 (ALIF) - Comprehensive guide to the anterior transperitoneal approach to L5–S1 for ALIF - midline laparotomy, bowel mobilisation, posterior peritoneal incision, superior hypogastric plexus preservation, vascular mobilisation between common iliac vessels, and critical danger structures for Orthopaedic and spine exam
  • Anterolateral Cervical Approach (Vertebral Artery Exposure) - Comprehensive guide to the anterolateral approach to the cervical spine for vertebral artery exposure - Verbiest's interval lateral to the carotid sheath, V2 transverse-foramen anatomy, sympathetic chain and recurrent laryngeal nerve dangers, and foramen unroofing for contemporary practice
  • Costotransversectomy Approach to the Thoracic Spine - Comprehensive guide to the costotransversectomy approach for posterolateral thoracic spine access - rib and transverse process resection, extrapleural dissection, intercostal neurovascular protection, and indications for thoracic disc herniation and vertebral pathology
  • Lateral Extracavitary Approach to the Thoracolumbar Spine - Comprehensive operative guide to the lateral extracavitary approach (LECA) for thoracolumbar spine - prone positioning, rib resection, extrapleural access, 270-degree decompression, corpectomy and posterior instrumentation in a single stage
  • Lateral Lumbar Interbody Fusion (XLIF) Approach - Comprehensive guide to the lateral transpsoas approach for XLIF with emphasis on lumbar plexus protection, psoas traversal technique, and comparison to anterior/posterior approaches
  • Minimally Invasive Tubular (Paramedian) Approach to the Lumbar Spine - Comprehensive guide to the minimally invasive tubular paramedian approach to the lumbar spine - prone positioning, muscle-splitting internervous plane, fluoro-guided serial dilation onto the lamina, microdiscectomy, over-the-top decompression and MIS-TLIF for Orthopaedic exam
  • OLIF (Oblique Lumbar Interbody Fusion) Approach - Comprehensive guide to the oblique retroperitoneal, pre-psoas (ante-psoas) corridor for OLIF at L2-L5 - right lateral decubitus positioning, the plane between the anterior border of the psoas and the great vessels, advantages over transpsoas XLIF and ALIF, the structures at risk (segmental vessels, sympathetic chain, ureter, iliac vessels), and the L5-S1 corridor limitation
  • Posterior Approach to Cervical Spine - Comprehensive guide to posterior cervical approaches for laminectomy, laminoplasty, and instrumentation with emphasis on vertebral artery protection, C5 nerve root palsy prevention, and subaxial screw techniques
  • Posterior Approach to Lumbar Spine - The posterior midline approach to the lumbar spine — subperiosteal dissection, laminectomy, microdiscectomy and pedicle-screw fusion, with dural-tear and cauda-equina management. advanced orthopaedic operative-surgery guide.
  • Posterior Approach to the Sacrum (Sacrectomy) - Comprehensive guide to the posterior approach to the sacrum for sacrectomy - prone positioning, midline sacral incision, gluteal reflection, sacrotuberous and sacrospinous ligament division, sacral nerve root preservation, presacral venous plexus and internal iliac vessel control, and lumbopelvic reconstruction for Orthopaedic exam
  • Posterior Occipitocervical Approach - Comprehensive guide to the posterior midline approach to the occiput and upper cervical spine for Orthopaedic exams - prone positioning with the head fixed, the avascular midline raphe (ligamentum nuchae), subperiosteal exposure of the occiput, C1 arch and C2, the vertebral artery on the C1 arch and at the C1-C2 facet, the C2 nerve root, and access for occipitocervical and atlantoaxial fusion
  • Posterolateral Transpedicular Approach to the Thoracic Spine - Comprehensive operative guide to the posterolateral transpedicular approach to the thoracic spine - prone posterior midline exposure, facet and pedicle removal to reach the anterior canal and vertebral body without thoracotomy, spinal cord protection, and posterior instrumented fusion
  • Presacral (AxiaLIF) Approach to L5-S1 - Comprehensive guide to the presacral (AxiaLIF) paracoccygeal approach to the L5-S1 disc - prone positioning and the presacral retrorectal avascular plane, blunt development of the plane anterior to the sacrum and posterior to the rectum under fluoroscopy, the transsacral trajectory through S1-S2 into the L5-S1 disc for an axial rod, the rectum, middle sacral vessels, presacral venous plexus and sacral nerves at risk, axial interbody fusion with posterior pedicle screw supplementation, and closure for orthopaedic exams
  • Retroperitoneal Anterolateral Approach to the Lumbar Spine - Comprehensive guide to the retroperitoneal anterolateral approach for lumbar spine surgery including anatomical intervals, vascular protection, and ALIF/corpectomy technique from L2-S1
  • Smith-Robinson Approach (Anterior Cervical Spine) - How to expose the anterior cervical spine through the Smith-Robinson approach - the left-sided visceral-vascular interval, carotid sheath and recurrent laryngeal nerve protection, longus colli elevation and level confirmation for safe ACDF. advanced orthopaedic operative-surgery guide.
  • Supraclavicular Approach to the Lower Cervical Spine and Brachial Plexus - Operative guide to the supraclavicular approach to the lower cervical spine, cervicothoracic junction and brachial plexus - transverse clavicular-crease incision, platysma, the supraclavicular nerves and external jugular vein, omohyoid, the scalene fat pad with the thoracic duct at risk on the left, the phrenic nerve on anterior scalene, and the subclavian vessels and plexus trunks between the scalenes - for the contemporary practice operative surgery examinations
  • Thoracoscopic (VATS) Approach to the Thoracic Spine - How to expose the anterior thoracic spine by video-assisted thoracoscopy (VATS) - lateral decubitus positioning, single-lung ventilation, portal placement over the superior rib border, rib-head and segmental-vessel anatomy, protecting the artery of Adamkiewicz, and the procedures performed (anterior release, discectomy, corpectomy, sympathectomy, biopsy). advanced orthopaedic operative-surgery guide.
  • Transforaminal Lumbar Interbody Fusion (TLIF) Approach - Comprehensive guide to the TLIF approach with emphasis on the unilateral facetectomy, Kambin's triangle, and protection of the exiting nerve root — the most vulnerable structure. advanced orthopaedic operative-surgery guide.
  • Transoral Approach to the Craniocervical Junction (C1–C2) - Comprehensive guide to the transoral approach for anterior craniocervical junction exposure - mouth retractor, soft palate split, anterior C1 arch and odontoid exposure, vertebral artery danger zones, and indications for irreducible anterior compression and basilar invagination
  • Transthoracic (Thoracotomy) Approach to the Thoracic Spine - Gold-standard guide to the transthoracic thoracotomy approach for anterior thoracic spine exposure - lateral decubitus positioning, rib resection two levels above target, left-sided preference, segmental vessel ligation, danger structures including artery of Adamkiewicz, and chest tube closure for corpectomy, tumour, infection and deformity
  • Wiltse Paraspinal (Intermuscular) Approach to the Lumbar Spine - Comprehensive guide to the Wiltse muscle-splitting paraspinal approach to the lumbar spine - paramedian incision, the intermuscular plane between multifidus and longissimus, direct access to the facet, pars and transverse process without midline stripping, the exiting nerve root as the danger, and its use for far-lateral disc, pars repair and pedicle screw placement for Orthopaedic exam

Hand & Wrist — 16 approaches

hand (16 approaches)

  • Approach to Guyon's Canal (Ulnar Nerve at the Wrist) - How to expose Guyon's canal (the ulnar tunnel) through the volar ulnar-sided wrist approach — the zig-zag incision ulnar to palmaris longus, the absence of a true internervous plane, the volar carpal ligament roof and transverse carpal ligament floor, the ulnar artery as the key danger, and the three anatomical zones around the hook of hamate. advanced orthopaedic operative-surgery guide.
  • Approach to the Distal Radioulnar Joint and Ulnar Head - How to expose the distal radioulnar joint (DRUJ) and ulnar head through the dorsal approach — the dorsoulnar incision, the intercompartmental interval between the fifth (EDM) and sixth (ECU) extensor compartments, protecting the dorsal sensory branch of the ulnar nerve and the ECU subsheath, and access for Darrach, Sauve-Kapandji, Bowers, ulnar head replacement, DRUJ arthrodesis and TFCC foveal repair. advanced orthopaedic operative-surgery guide.
  • Approach to the Flexor Sheath and A1 Pulley (Trigger Finger Release) - How to expose the flexor tendon sheath and A1 pulley of the digit for trigger finger and trigger thumb release — supine hand-table positioning, distal palmar crease landmarks, the absence of a true internervous plane, digital neurovascular bundle and thumb radial digital nerve protection, complete division of A1 while preserving A2, and skin-only closure for the orthopaedic exam.
  • Approach to the TFCC and Ulnar Side of the Wrist - Open ulnar approach to the triangular fibrocartilage complex (TFCC) and the distal radioulnar joint - the ECU-FCU internervous plane, dorsal sensory branch of the ulnar nerve, foveal reinsertion, and ulnar shortening for contemporary practice Orthopaedic exams
  • Bruner Volar Zigzag Approach to the Digit - Comprehensive guide to the Bruner volar zigzag approach to the finger for flexor tendon repair, pulley reconstruction, digital fracture fixation and infection drainage - incision design crossing flexion creases obliquely, neurovascular bundle protection, pulley preservation, and surgical technique for Orthopaedic exams
  • Dorsal Approach to Distal Radius - How to expose the distal radius through the dorsal (3rd-4th extensor compartment) approach — the Lister tubercle landmark, EPL transposition, superficial radial nerve protection, and dorsal buttress plating for dorsal Barton and comminuted Colles fractures. advanced orthopaedic operative-surgery guide.
  • Dorsal Approach to the Metacarpals and Phalanges - Comprehensive guide to the dorsal approach to the metacarpals and phalanges - longitudinal incision, extensor mechanism protection, sagittal band handling, subperiosteal exposure for plating and joint surgery - advanced orthopaedic practice level
  • Dorsal Approach to the Scaphoid - Comprehensive operative guide to the dorsal approach to the scaphoid for proximal-pole fixation and nonunion grafting - supine positioning, Lister's tubercle landmark, 3rd and 4th extensor compartment interval, preservation of the dorsal ridge blood supply, and antegrade headless compression screw placement for Orthopaedic exam
  • Dorsal Approach to the Wrist and Carpus - Comprehensive operative guide to the dorsal approach to the wrist and carpus for contemporary practice - supine positioning, Lister's tubercle landmark, the third-fourth extensor compartment interval, ligament-sparing capsulotomy, posterior interosseous nerve and dorsal sensory radial nerve protection, and the procedures performed through it including proximal row carpectomy, four-corner fusion and total wrist fusion
  • First Dorsal Compartment Approach (de Quervain Release) - Step-by-step surgical approach to the first dorsal (extensor) compartment of the wrist for de Quervain tenosynovitis release - supine positioning, radial styloid landmarks, superficial radial nerve protection, APL and EPB identification with EPB sub-sheath release, dorsal-margin sheath release to avoid volar tendon subluxation, and closure for the orthopaedic exam
  • Mid-Axial Approach to the Digit - Comprehensive operative guide to the mid-axial approach to the finger - incision placement on the non-contact border, internervous considerations, digital neurovascular bundle protection, dissection planes relative to Cleland and Grayson ligaments, and indications for phalangeal fixation and PIP joint surgery
  • Thompson Approach (Posterior Interosseous Nerve Exposure) - Comprehensive guide to the Thompson posterior interosseous approach to the proximal radius with emphasis on PIN protection, supinator splitting technique, and safe exposure of the proximal-middle radial shaft
  • Volar (Russe) Approach to the Scaphoid - How to expose the scaphoid through the volar (Russe) approach — the FCR-based interval, protecting the radial artery and the palmar cutaneous branch of the median nerve, division and repair of the radioscaphocapitate ligament, humpback deformity correction with a volar wedge graft, and the evidence on union. advanced orthopaedic operative-surgery guide.
  • Volar Approach to the Distal Radius (Henry / FCR Approach) - How to expose the distal radius through the volar (Henry/FCR) approach — the FCR interval, protecting the palmar cutaneous branch of the median nerve and radial artery, the pronator quadratus L-flap, the watershed line and Soong classification, and the dorsal tangential (skyline) check for screw length. advanced orthopaedic operative-surgery guide.
  • Volar Palmar (Flexor) Approach to the Carpal Canal and Mid-Palm - Gold-standard operative guide to the volar palmar approach for carpal tunnel release, flexor tendon surgery and mid-palmar pathology - incision planning, nerve protection, transverse carpal ligament division under vision, superficial palmar arch, extensile exposure and closure
  • Wagner Approach to the First CMC Joint (Volar) - How to expose the first carpometacarpal (basal thumb) joint through the Wagner volar approach — the thenar-crease incision, protecting the superficial radial nerve and radial artery, the internervous plane between the thenar muscles and adductor pollicis, subperiosteal thenar elevation and capsulotomy. advanced orthopaedic operative-surgery guide.

Foot & Ankle — 16 approaches

foot-ankle (16 approaches)

  • Achilles Tendon Approaches - How to expose the Achilles tendon for repair, reconstruction and debridement through the medial paramedian workhorse incision — sural nerve protection, the avascular watershed, Krackow repair, and extensile options (V-Y, turndown, FHL transfer). advanced orthopaedic operative-surgery guide.
  • Anterior Approach to the Ankle - Comprehensive guide to the anterior ankle surgical approach - internervous interval between tibialis anterior and EHL, surface anatomy, structures at risk, and indications for arthrodesis, arthroplasty, and fracture fixation
  • Anterolateral Approach to Ankle - Comprehensive guide to the anterolateral approach for ankle arthrodesis, syndesmotic injuries, and anterior ankle pathology - the workhorse approach for ankle fusion and anterior ankle surgery
  • Approach to the Posterior Tibial and Peroneal Tendons - Comprehensive guide to the medial and lateral approaches to the posterior tibial and peroneal tendons for tendon debridement, transfer, repair and groove deepening - tarsal tunnel protection, retinacular repair, and hindfoot tendon surgery for Orthopaedic exam
  • Approach to the Subtalar Joint - Sinus Tarsi Approach - Comprehensive guide to the sinus tarsi (Ollier) approach to the subtalar joint - lateral oblique incision, peroneal tendon retraction, EDB elevation, sural nerve protection, and exposure for subtalar arthrodesis and calcaneal fracture ORIF for Orthopaedic exams
  • Dorsal Approach to the Lesser Metatarsals - Comprehensive guide to the dorsal approach to the lesser metatarsals (second to fifth) for Weil osteotomy, fracture fixation, Freiberg disease surgery and ray amputation access - longitudinal incisions, dorsal cutaneous nerve protection, subperiosteal exposure of shaft neck and head, and layered closure for Orthopaedic exam
  • Dorsolateral Approach to the Talonavicular and Calcaneocuboid Joints - Comprehensive guide to the dorsolateral approaches to the Chopart (transverse tarsal) joints - the dorsal incision to the talonavicular joint lateral to tibialis anterior and extensor hallucis longus, the lateral incision to the calcaneocuboid joint, the deep peroneal nerve and dorsalis pedis bundle, the internervous planes, triple and double arthrodesis, calcaneonavicular coalition resection, and Chopart injury access for orthopaedic exams
  • Dorsomedial Approach to the First MTP Joint - Comprehensive guide to the dorsomedial approach to the first metatarsophalangeal joint for hallux valgus surgery, first MTPJ arthrodesis and cheilectomy - nerve protection, capsulotomy technique and closure for Orthopaedic exams
  • Lateral Approach to the Fifth Metatarsal and Cuboid - How to expose the lateral column of the foot through the lateral border approach to the fifth metatarsal and cuboid - lateral border incision, sural nerve protection, the inter-tendinous (not internervous) plane between peroneus brevis and peroneus longus, intramedullary Jones fracture fixation, cuboid ORIF, calcaneocuboid joint access and lateral column lengthening. advanced orthopaedic operative-surgery guide.
  • Medial Approach to Ankle (Medial Malleolus) - Comprehensive guide to the medial approach for medial malleolus fracture fixation, deltoid ligament repair, and medial ankle pathology - the standard approach for isolated medial malleolar fractures and medial-sided ankle injuries
  • Medial Approach to the Talus and Navicular - Comprehensive guide to the medial approach to the talus and navicular for talar neck fractures, medial talar dome OCD, talonavicular fusion and navicular fixation - saphenous nerve protection, deltoid ligament, artery of the tarsal canal and medial malleolar osteotomy for Orthopaedic exam
  • Medial Malleolar Osteotomy Approach to the Talar Dome - Comprehensive operative guide to the medial malleolar osteotomy for access to posteromedial osteochondral lesions of the talar dome - supine positioning, the deltoid-preserving chevron osteotomy, saphenous nerve and posteromedial neurovascular protection, and anatomic screw refixation for contemporary practice
  • Plantar Medial Approach to the Foot - Comprehensive guide to the plantar-medial approach to the foot - supine positioning with the leg externally rotated, the glabrous skin-junction incision that spares the weight-bearing sole, the abductor hallucis interval with no true internervous plane, protection of the medial and lateral plantar nerves and the posterior tibial bundle, and layered plantar closure - for contemporary practice orthopaedic exams
  • Posterolateral Approach to the Ankle - Comprehensive guide to the posterolateral approach to the ankle for posterior malleolar fixation, posterior pilon fragments and combined fibular plating - prone positioning, sural nerve protection, FHL interval and posterior tibial neurovascular bundle dangers for Orthopaedic exam
  • Posteromedial Approach to the Ankle - Comprehensive guide to the posteromedial approach to the ankle including tarsal tunnel contents, tibial nerve protection, exposure of the posteromedial distal tibia and medial malleolus for Orthopaedic exam preparation
  • Webspace Approach for Morton's Neuroma (Dorsal and Plantar) - Comprehensive operative exposure guide to the dorsal and plantar webspace approaches for excision of an interdigital (Morton's) neuroma - supine positioning, the intermetatarsal plane, division of the deep transverse intermetatarsal ligament, proximal nerve resection and stump-neuroma avoidance

Sports Medicine — 3 approaches

sports-medicine (3 approaches)

  • Knee Arthroscopy Approach - Comprehensive guide to knee arthroscopy portal placement, technique, indications, complications and exam points for Orthopaedic - anterolateral, anteromedial, accessory portals
  • Lateral Approach to the Knee (Iliotibial Band, LCL and Posterolateral Corner) - Comprehensive guide to the lateral approach to the knee for exposure of the iliotibial band, Gerdy's tubercle, lateral collateral ligament, popliteus and the posterolateral corner - positioning, the three-layer anatomy, the internervous plane, common peroneal nerve protection, step-by-step superficial and deep dissection, extensions, indications and closure for the Orthopaedic exam
  • Medial Approach to the Knee (Collateral Ligament and Meniscus) - Comprehensive guide to the medial approach to the knee for superficial and deep medial collateral ligament, posteromedial corner and medial meniscal work - Warren and Marshall layers, pes anserinus and saphenous nerve anatomy, indications, step-by-step dissection, danger structures, extensile options and closure for Orthopaedic exam

Shoulder & Elbow — 26 approaches

shoulder (26 approaches)

  • Anterior Approach to the Elbow (Antecubital) - Comprehensive guide to the anterior (antecubital) approach to the elbow as distal continuation of the Henry approach - lazy-S incision, brachial artery and median nerve protection, distal biceps repair, anterior capsular release, and radial nerve/PIN identification for Orthopaedic exam
  • Anterosuperior (Deltoid-Split) Approach to the Shoulder - Comprehensive operative guide to the anterosuperior deltoid-split approach to the shoulder - beach chair positioning, axillary nerve safe zone, limited deltoid split with stay sutures, coracoacromial ligament division, and exposure for rotator cuff repair and greater tuberosity fixation for Orthopaedic exams
  • Approach to the Acromioclavicular Joint - Comprehensive surgical approach guide to the acromioclavicular joint - superior strap incision, deltotrapezial fascia repair, CC ligament exposure, supraclavicular nerve protection for AC joint reconstruction and distal clavicle excision
  • Approach to the Radial Head and Neck - Comprehensive guide to the lateral approaches to the radial head and neck - the Kocher (anconeus-ECU) and Kaplan (ECRB-EDC) intervals, posterior interosseous nerve protection with forearm pronation, the non-articulating safe zone for plating, and lateral collateral ligament preservation for Orthopaedic exam
  • Axillary (Anteroinferior) Approach to the Shoulder - Cosmetic axillary-crease approach to the anterior glenohumeral joint for open Bankart repair, capsular shift and Latarjet coracoid transfer - hidden axillary incision, subcutaneous mobilisation to the coracoid, then the deltopectoral interval deep, with the cephalic vein, axillary nerve and musculocutaneous nerve as the key dangers.
  • Boyd Approach to the Proximal Radius and Ulna - Comprehensive operative guide to the Boyd posterolateral approach to the proximal radius and ulna - indications for Monteggia fixation and radial head arthroplasty, PIN protection via subperiosteal ulnar flap, radioulnar synostosis risk, and surgical steps
  • Brachial Plexus Exploration Approach - Combined supraclavicular and infraclavicular surgical approach to the brachial plexus for contemporary practice - positioning, interscalene and deltopectoral planes, step-by-step dissection of trunks and cords, danger structures, nerve transfer and closure for the Operative Surgery exam
  • Bryan-Morrey (Triceps-Reflecting) Approach to the Elbow - Comprehensive guide to the Bryan-Morrey medial-to-lateral triceps-reflecting approach to the elbow for total elbow arthroplasty and distal humeral reconstruction - posterior incision, ulnar nerve identification and transposition, subperiosteal reflection of the extensor mechanism in continuity, wide exposure of the distal humerus and elbow joint, and secure transosseous triceps reattachment for contemporary practice
  • Coracoid / Latarjet Approach (Subscapularis Split) - Comprehensive guide to the open coracoid / Latarjet approach to the anteroinferior glenoid for recurrent anterior shoulder instability with glenoid bone loss - deltopectoral interval, coracoid osteotomy, the horizontal subscapularis split, protection of the musculocutaneous and axillary nerves, and two-screw graft fixation for the Orthopaedic exam
  • Deltopectoral Approach to Shoulder - Comprehensive guide to the deltopectoral approach for shoulder arthroplasty, proximal humerus fractures, and anterior shoulder pathology - the workhorse internervous plane approach to the glenohumeral joint
  • Extended Lateral Deltoid-Split Approach to the Shoulder - Comprehensive guide to the extended lateral deltoid-split approach to the shoulder for the contemporary practice - beach-chair positioning, splitting the middle deltoid through its avascular raphe, the critical axillary nerve safe zone 5 to 7 cm distal to the acromion, access to the greater tuberosity and supraspinatus, minimally invasive plating of proximal humeral fractures, rotator cuff repair and deltoid repair on closure.
  • Extensile Posterior (Global) Approach to the Elbow - Comprehensive guide to the extensile posterior (global) approach to the elbow - a single posterior skin incision lateral to the olecranon tip, full-thickness fasciocutaneous flaps exposing both columns, ulnar nerve handling, and selection of the deep window (paratricipital, triceps-splitting, olecranon osteotomy, or triceps-reflecting) for complex distal humeral fractures, total elbow arthroplasty and ankylosis - for the contemporary practice Orthopaedic exams
  • Judet Posterior Approach to the Scapula - Comprehensive guide to the Judet posterior approach to the scapula for scapular body, neck and glenoid fractures - prone or lateral positioning, the boomerang incision, the infraspinatus-teres minor internervous plane, and protection of the suprascapular nerve for Orthopaedic exam
  • Kaplan Approach to the Elbow (Lateral, EDC–ECRB Interval) - Comprehensive operative guide to the Kaplan lateral approach to the elbow through the EDC–ECRB interval for radial head and capitellar exposure - internervous plane, PIN protection with pronation, extensile options, and comparison to Kocher approach for Orthopaedic exams
  • Kocher Approach to the Elbow - How to expose the lateral elbow through the Kocher (anconeus–ECU) internervous interval — the curved lateral incision, protecting the posterior interosseous nerve by supinating the forearm, capsulotomy and radial-head access, and repair of the LUCL. advanced orthopaedic operative-surgery guide.
  • Lateral Approach to Proximal Humerus - How to expose the greater tuberosity, rotator cuff and lateral humeral head through the deltoid-splitting (anterolateral acromial) approach — the safe-zone rule for the axillary nerve, splitting parallel to the deltoid fibres, deltoid-origin elevation, and fixation of greater tuberosity fractures. advanced orthopaedic operative-surgery guide.
  • Medial (Hotchkiss Over-the-Top) Approach to the Elbow - Comprehensive operative guide to the Hotchkiss medial over-the-top approach to the elbow for coronoid fractures, MCL reconstruction and anteromedial access - ulnar nerve management, internervous plane, and step-by-step exposure for Orthopaedic exams
  • Medial Epicondylar Osteotomy Approach to the Elbow - Comprehensive guide to the medial approach to the elbow enhanced by an osteotomy of the medial epicondyle for access to the coronoid, the anteromedial facet and the medial column of the distal humerus - ulnar nerve identification and transposition, reflection of the flexor-pronator origin and the anterior band of the medial collateral ligament with the epicondyle, predrilling and screw reattachment, and the risks of MCL incompetence and ulnar neuritis for contemporary practice
  • Posterior Approach to the Elbow - Comprehensive guide to the posterior approach to the elbow including triceps-splitting, triceps-reflecting (Bryan-Morrey), and olecranon osteotomy techniques for distal humerus fractures and total elbow arthroplasty
  • Posterior Approach to the Shoulder - Comprehensive guide to the posterior surgical approach to the shoulder - indications, technique, internervous plane, complications, and clinical applications for orthopaedic exam
  • Shoulder Arthroscopy Approach - Comprehensive guide to shoulder arthroscopy portal placement, positioning, technique, indications, complications and exam points for Orthopaedic examination
  • Sternoclavicular Joint Approach - Comprehensive guide to the anterior approach to the sternoclavicular joint for advanced orthopaedic practice - supine positioning with a bolster between the shoulders, the internervous interval between sternocleidomastoid and pectoralis major, the great vessels and mediastinum immediately posterior, resection arthroplasty and figure-of-eight reconstruction
  • Subscapularis Management in Shoulder Arthroplasty - Comprehensive operative-surgery guide to managing the subscapularis during anatomic shoulder arthroplasty through the deltopectoral approach - tenotomy versus subscapularis peel versus lesser-tuberosity osteotomy, biomechanics and healing, repair constructs, the axillary nerve at the inferior border, restoration of tension and version, and closure for the contemporary practice
  • Superior (Transacromial / Saber-Cut) Approach to the Shoulder - Comprehensive guide to the superior approach to the shoulder - beach-chair positioning, deltoid split versus trapezius-deltoid takedown versus acromial osteotomy, exposure of the supraspinatus and superior glenohumeral joint, axillary and suprascapular nerve protection, and deltoid reattachment for contemporary practice operative surgery exams
  • TRAP (Triceps-Reflecting Anconeus Pedicle) Approach to the Elbow - Comprehensive guide to the TRAP (triceps-reflecting anconeus pedicle) approach to the distal humerus and elbow - lateral Kocher and medial interval dissection, ulnar nerve protection, elevation of the triceps-anconeus as a distally-based pedicle preserving anconeus blood supply, and bilateral column exposure without an olecranon osteotomy for Orthopaedic exam
  • Wrightington (Extended Lateral) Approach to the Elbow - Comprehensive guide to the Wrightington extended lateral approach to the elbow for distal humeral and capitellar fractures and elbow arthroplasty access - supine positioning, the ECU-anconeus (Kocher) interval extended proximally, PIN protection by forearm pronation, lateral collateral ligament preservation on a bone fleck, and LCL repair to prevent posterolateral rotatory instability
Operative approaches

Approach guides.

Surgical approaches in full: positioning and landmarks, the internervous plane, the dissection step by step, the structures at risk, and how each compares with its alternatives.

Operative approaches (148)Browse operative procedures →
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Operative guides

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Complex operations

Procedure method

Plan the operation

Start with indication, contraindications, consent risks, patient position, imaging, equipment, and backup options.

Operate by sequence

Rehearse exposure, interval, reduction or reconstruction, fixation choices, structures at risk, and closure.

Finish with rescue

Know aftercare, complications, failure modes, and what you will do when the first plan is not safe.

Operative regions
148 procedures
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Start with the setup

Open a guide and rehearse the operation out loud from indication through positioning, approach, dissection, fixation or reconstruction, closure, and aftercare.

Open first guide

Safety

Know the danger structures

Treat every operative guide as a risk map: what can be injured, when it is exposed, and how the plan changes if anatomy or fixation is unsafe.

Preparation

Indication, consent risks, imaging, equipment, patient position, draping, antibiotics, and backup implants.

Technique

Approach, interval, reduction or reconstruction, fixation, trialling, stability checks, and closure.

Aftercare

Weight-bearing, immobilisation, rehabilitation, complication surveillance, and failure management.

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