Operative Approaches | 151+ Surgical Approach Guides

Operative Approaches Workbench - 151+ 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.
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 and Safe Surgical Dislocation of the Hip - Vascular-preserving trochanteric flip osteotomy, anterosuperior capsulotomy, surgical hip dislocation and stable trochanteric reattachment
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) - Consultant-level guide to the Hardinge direct lateral approach to the hip, including selection, anatomy, staged exposure, reconstruction branches, abductor repair, aftercare, complications, and evidence.
Hip Posterior Approach (Moore/Southern) - Consultant-level guide to posterior hip exposure, including patient selection, variable sciatic anatomy, standard and tissue-sparing branches, posterior repair, extensions, aftercare and instability assessment.
Medial Approaches to the Hip in Paediatric DDH - Consultant-level guide to Ludloff, Ferguson and posteromedial exposures for paediatric developmental dysplasia of the hip, including selection, anatomy, open reduction, complications and surveillance.
Medial Parapatellar Approach to the Knee - Standard anterior knee exposure through a medial parapatellar arthrotomy, including safe patellar mobilisation, controlled medial release, closure and extensile options
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.
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 - Surgeon-level guide to standard trochanteric osteotomy, trochanteric slide and extended trochanteric osteotomy for complex primary and revision hip arthroplasty
Two-Incision Minimally Invasive Approach to the Hip - Surgeon-level guide to the historical two-incision minimally invasive total hip arthroplasty technique, its anterior and posterior working corridors, fluoroscopic and direct-vision variants, complications and limited contemporary role

Trauma — 48 approaches

trauma (48 approaches)

Anterior Approach to the Humeral Shaft - Consultant-level operative guide to the anterior and anterolateral humeral shaft exposure, fracture fixation, radial nerve strategy and failure rescue
Anterior Approach to the Sacroiliac Joint - Consultant-level guide to the selective anterior sacroiliac approach: injury mapping, lateral-window exposure, L5 and vascular protection, open reduction, adjunct fixation, imaging, complications and revision planning
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.
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.
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.
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 Plating - Surgeon-level guide to superior and anteroinferior clavicle exposure for fracture fixation and reconstruction, including supraclavicular-nerve preservation, muscle and periosteal handling, plate-position selection, guarded drilling above the subclavian bundle and pleura, reduction strategy, closure and complications.
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.
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 the Midfoot - Safe dorsal exposure of the naviculocuneiform and tarsometatarsal joints with protection of skin, tendons and neurovascular structures
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 - Selective extensile exposure of both acetabular columns, with anatomy-led approach choice, optional trochanteric osteotomy, neurovascular protection and complication prevention
Extensile Lateral Approach to the Calcaneus - Operative guide to the extensile lateral calcaneal approach: soft-tissue selection, L-shaped incision, full-thickness no-touch flap, posterior-facet reduction, plate fixation, closure and wound-failure rescue.
Extensile Smith-Petersen / Iliofemoral Anterior Approach to the Acetabulum and Anterior Column - Gold-standard guide to the extensile Smith-Petersen / iliofemoral anterior approach to the acetabulum and anterior column - supine positioning, the sartorius-TFL and rectus femoris-gluteus medius internervous planes, lateral femoral cutaneous nerve protection, subperiosteal iliac-table exposure, procedures, closure, and distinction from the classic extended iliofemoral approach
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 - Layer-by-layer surgical anatomy and safe execution of the Smith-Petersen anterior approach to the hip, with clear boundaries from direct anterior arthroplasty and extensile iliofemoral exposure.
Hip Anterolateral Approach — Watson-Jones - Layer-by-layer anatomy and safe execution of the Watson-Jones anterolateral hip approach, with superior gluteal nerve protection, abductor preservation and clear boundaries from direct lateral and anterior approaches.
Iliac (Lateral Window) Approach to the Pelvis - Operative guide to the iliac or lateral window approach: selection, CT planning, lateral femoral cutaneous nerve protection, subperiosteal iliacus elevation, high anterior-column reduction, fixation, imaging and closure.
Ilioinguinal Approach to the Acetabulum - Operative guide to the classic ilioinguinal approach: fracture selection, three-window anatomy, lateral femoral cutaneous nerve protection, external iliac vessel mobilisation, corona mortis control, reduction, fixation and closure.
Kocher-Langenbeck Approach to the Acetabulum - Consultant-level guide to the Kocher-Langenbeck posterior acetabular approach, including CT and Judet planning, stability assessment, surgical anatomy, sciatic nerve protection, reduction, fixation, closure, aftercare, complications, and examination preparation
Lateral and Posterolateral Approaches to the Distal Humeral Shaft - Operative guide to anterolateral, triceps-sparing posterolateral and distal lateral-column exposure of the distal humeral shaft, with radial-nerve strategy, fracture-specific fixation, minimally invasive plating, complication management and rehabilitation.
Lateral Approach to the Femoral Shaft - Operative guide to open subvastus and minimally invasive lateral femoral exposure, including fracture-led approach selection, vastus lateralis and profunda anatomy, haemorrhage control, reduction, plate mechanics, distal extension, complications and rehabilitation.
Lateral Approach to the Fibula and Lateral Malleolus - Operative guide to direct lateral, posterolateral and anterior-distal fibular exposure, including soft-tissue timing, superficial peroneal and sural nerve protection, fibular reduction, lateral and antiglide plating, syndesmotic assessment, complications and rehabilitation.
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.
Pararectus Approach to the Acetabulum - How to reach the anterior column and quadrilateral plate through one anterior-intrapelvic window — the single-incision alternative that took the ilioinguinal's medial window and the Stoppa's intrapelvic view and combined them along the lateral border of rectus abdominis, the corona mortis that must be found and ligated in the first centimetres, the obturator neurovascular bundle and external iliac vessels bounding the working space, quadrilateral-plate buttress plating for the elderly medial-migration fracture, extending windows along the pelvic brim, and the honest comparison with ilioinguinal and Stoppa exposures.
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 - Decision-led operative guide to central posterior, posteromedial and posterolateral corridors around the distal femur and popliteal fossa.
Posterior Approach to the Distal Tibia (Posterior Malleolus) - Decision-led guide to posterolateral and posteromedial corridors for posterior malleolar and posterior pilon fractures.
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.
Posterior Triceps-Sparing (Paratricipital) Approach to the Humerus - Operative guide to the posterior paratricipital approach for distal humeral shaft and selected distal humerus surgery, including two-window anatomy, radial and ulnar nerve protection, exposure limits, fixation, conversion, closure and rehabilitation.
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.
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.
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.
Triradiate Extensile Approach to the Acetabulum - Surgeon-level guide to the historical triradiate extensile approach for complex acetabular fractures, including the Y incision, trochanteric osteotomy, dome exposure, posterior-column dissection, limitations and complication burden

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.
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
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 - Consultant-level guide to posterolateral thoracic costotransversectomy: level localisation, rib-head and transverse-process removal, extrapleural vertebral-body access, disc or tumour decompression, reconstruction and pleural or neurological complication management.
High Anterior Retropharyngeal Approach to the Upper Cervical Spine - Consultant-level planning and operative guide to high anterior transcervical and retropharyngeal exposure of C1–C3: route selection, airway and vascular planning, cranial-nerve safety, prevertebral dissection, target-specific reconstruction, rescue and postoperative care
Lateral Extracavitary Approach to the Thoracic and Thoracolumbar Spine - Operative guide to lateral extracavitary exposure for thoracic and thoracolumbar decompression, corpectomy, anterior-column reconstruction and posterior fixation
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.
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 - Consultant-level guide to the rarely used presacral axial lumbar interbody fusion approach at L5-S1, covering restricted contemporary use, patient selection, cross-sectional trajectory planning, retrorectal anatomy, a criteria-led 14-stage technique, abort thresholds, colorectal contingency, fixation, aftercare, complications, alternatives and evidence limitations.
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.
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).
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.
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
Transperitoneal Anterior Exposure for L5–S1 ALIF - Consultant-level guide to selected transperitoneal anterior exposure for L5–S1 ALIF, covering route selection, vascular imaging, autonomic plexus preservation, interiliac exposure, implant strategy, closure and complication rescue
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 Approach to the Lumbar Spine - Surgeon-level guide to the Wiltse paraspinal approach: patient-specific localisation of the multifidus–longissimus cleavage plane, target-directed exposure of the facet, pars and transverse process, far-lateral disc surgery, pedicle fixation and neural safety

Hand & Wrist — 16 approaches

hand (16 approaches)

Approach to the Flexor Sheath and A1 Pulley - A procedure-specific guide to open A1 pulley release in the finger and thumb: diagnostic selection, WALANT or tourniquet strategy, applied pulley anatomy, digital nerve protection, complete longitudinal A1 division with A2 preservation, intra-operative glide testing, revision, complications and rehabilitation.
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.
Dorsal Approach to the Distal Radioulnar Joint and Ulnar Head - Surgeon-level guide to the dorsal DRUJ approach through the fifth extensor compartment, with protection of the dorsal cutaneous branch of the ulnar nerve, preservation of the ECU subsheath and repairable capsular exposure for TFCC, salvage and arthroplasty procedures.
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 - Surgeon-level guide to open, mini-open, percutaneous and arthroscopic-assisted dorsal scaphoid access for proximal-pole fracture fixation and selected nonunion reconstruction, including approach selection, wrist positioning, extensor intervals, ligament-sparing capsulotomy, guidewire and screw control, bone graft harvest, closure and complications.
Dorsal Approach to the Wrist and Carpus - Operative guide to dorsal wrist and carpal exposure: route selection, extensor-retinacular handling, third-fourth compartment dissection, terminal posterior interosseous nerve, ligament-splitting capsulotomy, cartilage assessment, procedure-specific extensions and safe closure
First Dorsal Compartment Approach and de Quervain Release - Operative guide to diagnosis-led first extensor compartment decompression, including APL and EPB variants, superficial radial nerve protection, open and tendoscopic release, dynamic stability testing, rehabilitation and revision strategy.
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
Open Decompression of Guyon's Canal and the Distal Ulnar Nerve - Surgeon-level guide to open Guyon canal decompression: clinical localisation by zone, proximal ulnar neurovascular control, release of the palmar carpal ligament and pisohamate hiatus, protection of the deep motor branch and lesion-specific extensions.
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.
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.
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 Anterolateral Approach to the First CMC Joint - Operative guide to the Wagner anterolateral, or volar-radial, approach to the thumb carpometacarpal joint: approach selection, radial sensory nerve anatomy, thenar elevation, capsulotomy, flexor carpi radialis protection, trapezial exposure, closure, complications and rehabilitation.

Foot & Ankle — 18 approaches

foot-ankle (18 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).
Anterior Approach to the Ankle - Consultant-level guide to selecting, planning and executing the direct anterior ankle approach, including neurovascular anatomy, total ankle arthroplasty, fusion, pilon fracture windows, rescue strategies and complications
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
Dorsomedial and Dorsolateral Approaches to the Chopart Joints - Operative guide to pathology-led exposure of the talonavicular and calcaneocuboid joints, including the tibialis anterior–EHL interval, dorsalis pedis bundle, dorsolateral cuboid approach, combined skin bridge, arthrodesis, Chopart reconstruction and calcaneonavicular coalition resection
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 - Operative guide to fifth-metatarsal base and lateral-midfoot exposure, including sural nerve and peroneal tendon anatomy, Jones screw fixation, open base fixation, cuboid reconstruction, calcaneocuboid reduction, lateral-column lengthening, complications and rehabilitation.
Lateral Transmalleolar Approach to the Talus - How to reach the lateral talar dome through a fibular osteotomy — the posterolateral osteochondral lesions and lateral dome fractures that arthroscopy and arthrotomy cannot reach perpendicular, the medial malleolar osteotomy's mirror-image counterpart argued honestly, pre-drilling the fibula before the oblique osteotomy so anatomical repair is guaranteed, protecting the peroneals behind and the anterior neurovascular structures in front, the lateral ligament and syndesmotic disciplines that keep the ankle stable afterwards, and the fixation-and-union arithmetic of an osteotomy made only to be put back.
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 Calcaneus and Sustentaculum Tali - How to reach the calcaneus from its dangerous side — the sustentacular fractures, medial-wall fragments and constant-fragment fixation that only the medial window serves, the neurovascular bundle (posterior tibial artery and tibial nerve dividing into medial and lateral plantar branches) that owns this territory and the flexor hallucis longus that runs directly beneath the sustentaculum, the interval between flexor digitorum longus and the bundle, why the sustentaculum is the 'constant fragment' every calcaneal reconstruction references, combined medial-lateral strategies for complex fractures, and the small-screw fixation this dense corner of bone rewards.
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 Approaches for Interdigital (Morton) Neuroma - Procedure-specific guide to dorsal and plantar webspace exposure for interdigital nerve surgery: diagnostic confirmation, approach selection, deep transverse intermetatarsal ligament control, nerve identification, neurectomy, decompression, revision strategy, closure and rehabilitation

Sports Medicine — 3 approaches

sports-medicine (3 approaches)

Knee Arthroscopy Approach - A pathology-led operative guide to safe knee arthroscopy: patient selection, anterior and posterior portal creation, systematic examination, triangulation, complications and evidence.
Lateral Approach to the Knee: ITB, FCL and Posterolateral Corner - Operative guide to target-specific lateral-knee exposure, including iliotibial-band and Gerdy anatomy, fibular collateral ligament and posterolateral-corner dissection, common fibular nerve protection, repair and reconstruction, complications and rehabilitation.
Medial Approach to the Knee: MCL, Posteromedial Corner and Meniscus - Operative guide to target-specific medial-knee exposure, including superficial and deep MCL anatomy, posterior oblique ligament, saphenous nerve and pes protection, anatomical repair and reconstruction, posteromedial meniscal access, complications and rehabilitation.

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
Anterior Axillary-Crease Approach to the Shoulder - Surgeon-level guide to the anterior axillary-crease skin route for selected open anterior shoulder stabilisation, with full-thickness flap mobilisation to the deltopectoral interval, cephalic-vein management, subscapularis and capsular access, and protection of the musculocutaneous and axillary nerves.
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
Boyd Approach — Proximal Radius and Ulna - Consultant-level guide to the classic and modified Boyd posterolateral approach: patient selection, proximal-ulnar and radial-head exposure, posterior interosseous nerve protection, ligament-preserving dissection, fixation sequence, closure and complication rescue
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 - Operative guide to short lateral, extended anterolateral and two-window deltoid-split exposures of the proximal humerus, with direct axillary-nerve protection, fracture-specific reduction, safe plate passage and deltoid-preserving 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 pronating the forearm, capsulotomy and radial-head access, and repair of the LUCL.
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.
Lateral Approaches to the Radial Head and Neck - Surgeon-level guide to Kocher, Kaplan and EDC-splitting exposures of the radial head and neck, with LUCL preservation, posterior interosseous nerve protection, dynamic hardware placement and procedure-specific closure.
Medial (Hotchkiss Over-the-Top) Approach to the Elbow - Consultant operative guide to the anterior medial Hotchkiss over-the-top approach for coronoid-tip, anterior-capsular and selected anteromedial coronoid exposure, with anatomy-led approach selection, nerve protection, fixation strategy and stability-guided rehabilitation.
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 - Operative guide to the triceps-reflecting anconeus pedicle approach for distal-humeral fractures and nonunions: ulnar-nerve protection, modified Kocher and medial exposures, proximal reflection of the triceps-anconeus flap, dual-column fixation, transosseous triceps repair and rehabilitation
Wrightington Approach to the Radial Head - Surgeon-level guide to the true Wrightington approach: posterior radial-head exposure by subperiosteal anconeus elevation and a repairable supinator-tuberosity bone-fleck osteotomy carrying the annular and lateral ligament complex

Operative Approaches Workbench - 151+ Surgical 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.
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 and Safe Surgical Dislocation of the Hip - Vascular-preserving trochanteric flip osteotomy, anterosuperior capsulotomy, surgical hip dislocation and stable trochanteric reattachment
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) - Consultant-level guide to the Hardinge direct lateral approach to the hip, including selection, anatomy, staged exposure, reconstruction branches, abductor repair, aftercare, complications, and evidence.
Hip Posterior Approach (Moore/Southern) - Consultant-level guide to posterior hip exposure, including patient selection, variable sciatic anatomy, standard and tissue-sparing branches, posterior repair, extensions, aftercare and instability assessment.
Medial Approaches to the Hip in Paediatric DDH - Consultant-level guide to Ludloff, Ferguson and posteromedial exposures for paediatric developmental dysplasia of the hip, including selection, anatomy, open reduction, complications and surveillance.
Medial Parapatellar Approach to the Knee - Standard anterior knee exposure through a medial parapatellar arthrotomy, including safe patellar mobilisation, controlled medial release, closure and extensile options
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.
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 - Surgeon-level guide to standard trochanteric osteotomy, trochanteric slide and extended trochanteric osteotomy for complex primary and revision hip arthroplasty
Two-Incision Minimally Invasive Approach to the Hip - Surgeon-level guide to the historical two-incision minimally invasive total hip arthroplasty technique, its anterior and posterior working corridors, fluoroscopic and direct-vision variants, complications and limited contemporary role

Trauma — 48 approaches

trauma (48 approaches)

Anterior Approach to the Humeral Shaft - Consultant-level operative guide to the anterior and anterolateral humeral shaft exposure, fracture fixation, radial nerve strategy and failure rescue
Anterior Approach to the Sacroiliac Joint - Consultant-level guide to the selective anterior sacroiliac approach: injury mapping, lateral-window exposure, L5 and vascular protection, open reduction, adjunct fixation, imaging, complications and revision planning
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.
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.
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.
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 Plating - Surgeon-level guide to superior and anteroinferior clavicle exposure for fracture fixation and reconstruction, including supraclavicular-nerve preservation, muscle and periosteal handling, plate-position selection, guarded drilling above the subclavian bundle and pleura, reduction strategy, closure and complications.
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.
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 the Midfoot - Safe dorsal exposure of the naviculocuneiform and tarsometatarsal joints with protection of skin, tendons and neurovascular structures
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 - Selective extensile exposure of both acetabular columns, with anatomy-led approach choice, optional trochanteric osteotomy, neurovascular protection and complication prevention
Extensile Lateral Approach to the Calcaneus - Operative guide to the extensile lateral calcaneal approach: soft-tissue selection, L-shaped incision, full-thickness no-touch flap, posterior-facet reduction, plate fixation, closure and wound-failure rescue.
Extensile Smith-Petersen / Iliofemoral Anterior Approach to the Acetabulum and Anterior Column - Gold-standard guide to the extensile Smith-Petersen / iliofemoral anterior approach to the acetabulum and anterior column - supine positioning, the sartorius-TFL and rectus femoris-gluteus medius internervous planes, lateral femoral cutaneous nerve protection, subperiosteal iliac-table exposure, procedures, closure, and distinction from the classic extended iliofemoral approach
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 - Layer-by-layer surgical anatomy and safe execution of the Smith-Petersen anterior approach to the hip, with clear boundaries from direct anterior arthroplasty and extensile iliofemoral exposure.
Hip Anterolateral Approach — Watson-Jones - Layer-by-layer anatomy and safe execution of the Watson-Jones anterolateral hip approach, with superior gluteal nerve protection, abductor preservation and clear boundaries from direct lateral and anterior approaches.
Iliac (Lateral Window) Approach to the Pelvis - Operative guide to the iliac or lateral window approach: selection, CT planning, lateral femoral cutaneous nerve protection, subperiosteal iliacus elevation, high anterior-column reduction, fixation, imaging and closure.
Ilioinguinal Approach to the Acetabulum - Operative guide to the classic ilioinguinal approach: fracture selection, three-window anatomy, lateral femoral cutaneous nerve protection, external iliac vessel mobilisation, corona mortis control, reduction, fixation and closure.
Kocher-Langenbeck Approach to the Acetabulum - Consultant-level guide to the Kocher-Langenbeck posterior acetabular approach, including CT and Judet planning, stability assessment, surgical anatomy, sciatic nerve protection, reduction, fixation, closure, aftercare, complications, and examination preparation
Lateral and Posterolateral Approaches to the Distal Humeral Shaft - Operative guide to anterolateral, triceps-sparing posterolateral and distal lateral-column exposure of the distal humeral shaft, with radial-nerve strategy, fracture-specific fixation, minimally invasive plating, complication management and rehabilitation.
Lateral Approach to the Femoral Shaft - Operative guide to open subvastus and minimally invasive lateral femoral exposure, including fracture-led approach selection, vastus lateralis and profunda anatomy, haemorrhage control, reduction, plate mechanics, distal extension, complications and rehabilitation.
Lateral Approach to the Fibula and Lateral Malleolus - Operative guide to direct lateral, posterolateral and anterior-distal fibular exposure, including soft-tissue timing, superficial peroneal and sural nerve protection, fibular reduction, lateral and antiglide plating, syndesmotic assessment, complications and rehabilitation.
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.
Pararectus Approach to the Acetabulum - How to reach the anterior column and quadrilateral plate through one anterior-intrapelvic window — the single-incision alternative that took the ilioinguinal's medial window and the Stoppa's intrapelvic view and combined them along the lateral border of rectus abdominis, the corona mortis that must be found and ligated in the first centimetres, the obturator neurovascular bundle and external iliac vessels bounding the working space, quadrilateral-plate buttress plating for the elderly medial-migration fracture, extending windows along the pelvic brim, and the honest comparison with ilioinguinal and Stoppa exposures.
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 - Decision-led operative guide to central posterior, posteromedial and posterolateral corridors around the distal femur and popliteal fossa.
Posterior Approach to the Distal Tibia (Posterior Malleolus) - Decision-led guide to posterolateral and posteromedial corridors for posterior malleolar and posterior pilon fractures.
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.
Posterior Triceps-Sparing (Paratricipital) Approach to the Humerus - Operative guide to the posterior paratricipital approach for distal humeral shaft and selected distal humerus surgery, including two-window anatomy, radial and ulnar nerve protection, exposure limits, fixation, conversion, closure and rehabilitation.
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.
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.
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.
Triradiate Extensile Approach to the Acetabulum - Surgeon-level guide to the historical triradiate extensile approach for complex acetabular fractures, including the Y incision, trochanteric osteotomy, dome exposure, posterior-column dissection, limitations and complication burden

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.
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
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 - Consultant-level guide to posterolateral thoracic costotransversectomy: level localisation, rib-head and transverse-process removal, extrapleural vertebral-body access, disc or tumour decompression, reconstruction and pleural or neurological complication management.
High Anterior Retropharyngeal Approach to the Upper Cervical Spine - Consultant-level planning and operative guide to high anterior transcervical and retropharyngeal exposure of C1–C3: route selection, airway and vascular planning, cranial-nerve safety, prevertebral dissection, target-specific reconstruction, rescue and postoperative care
Lateral Extracavitary Approach to the Thoracic and Thoracolumbar Spine - Operative guide to lateral extracavitary exposure for thoracic and thoracolumbar decompression, corpectomy, anterior-column reconstruction and posterior fixation
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.
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 - Consultant-level guide to the rarely used presacral axial lumbar interbody fusion approach at L5-S1, covering restricted contemporary use, patient selection, cross-sectional trajectory planning, retrorectal anatomy, a criteria-led 14-stage technique, abort thresholds, colorectal contingency, fixation, aftercare, complications, alternatives and evidence limitations.
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.
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).
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.
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
Transperitoneal Anterior Exposure for L5–S1 ALIF - Consultant-level guide to selected transperitoneal anterior exposure for L5–S1 ALIF, covering route selection, vascular imaging, autonomic plexus preservation, interiliac exposure, implant strategy, closure and complication rescue
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 Approach to the Lumbar Spine - Surgeon-level guide to the Wiltse paraspinal approach: patient-specific localisation of the multifidus–longissimus cleavage plane, target-directed exposure of the facet, pars and transverse process, far-lateral disc surgery, pedicle fixation and neural safety

Hand & Wrist — 16 approaches

hand (16 approaches)

Approach to the Flexor Sheath and A1 Pulley - A procedure-specific guide to open A1 pulley release in the finger and thumb: diagnostic selection, WALANT or tourniquet strategy, applied pulley anatomy, digital nerve protection, complete longitudinal A1 division with A2 preservation, intra-operative glide testing, revision, complications and rehabilitation.
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.
Dorsal Approach to the Distal Radioulnar Joint and Ulnar Head - Surgeon-level guide to the dorsal DRUJ approach through the fifth extensor compartment, with protection of the dorsal cutaneous branch of the ulnar nerve, preservation of the ECU subsheath and repairable capsular exposure for TFCC, salvage and arthroplasty procedures.
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 - Surgeon-level guide to open, mini-open, percutaneous and arthroscopic-assisted dorsal scaphoid access for proximal-pole fracture fixation and selected nonunion reconstruction, including approach selection, wrist positioning, extensor intervals, ligament-sparing capsulotomy, guidewire and screw control, bone graft harvest, closure and complications.
Dorsal Approach to the Wrist and Carpus - Operative guide to dorsal wrist and carpal exposure: route selection, extensor-retinacular handling, third-fourth compartment dissection, terminal posterior interosseous nerve, ligament-splitting capsulotomy, cartilage assessment, procedure-specific extensions and safe closure
First Dorsal Compartment Approach and de Quervain Release - Operative guide to diagnosis-led first extensor compartment decompression, including APL and EPB variants, superficial radial nerve protection, open and tendoscopic release, dynamic stability testing, rehabilitation and revision strategy.
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
Open Decompression of Guyon's Canal and the Distal Ulnar Nerve - Surgeon-level guide to open Guyon canal decompression: clinical localisation by zone, proximal ulnar neurovascular control, release of the palmar carpal ligament and pisohamate hiatus, protection of the deep motor branch and lesion-specific extensions.
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.
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.
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 Anterolateral Approach to the First CMC Joint - Operative guide to the Wagner anterolateral, or volar-radial, approach to the thumb carpometacarpal joint: approach selection, radial sensory nerve anatomy, thenar elevation, capsulotomy, flexor carpi radialis protection, trapezial exposure, closure, complications and rehabilitation.

Foot & Ankle — 18 approaches

foot-ankle (18 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).
Anterior Approach to the Ankle - Consultant-level guide to selecting, planning and executing the direct anterior ankle approach, including neurovascular anatomy, total ankle arthroplasty, fusion, pilon fracture windows, rescue strategies and complications
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
Dorsomedial and Dorsolateral Approaches to the Chopart Joints - Operative guide to pathology-led exposure of the talonavicular and calcaneocuboid joints, including the tibialis anterior–EHL interval, dorsalis pedis bundle, dorsolateral cuboid approach, combined skin bridge, arthrodesis, Chopart reconstruction and calcaneonavicular coalition resection
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 - Operative guide to fifth-metatarsal base and lateral-midfoot exposure, including sural nerve and peroneal tendon anatomy, Jones screw fixation, open base fixation, cuboid reconstruction, calcaneocuboid reduction, lateral-column lengthening, complications and rehabilitation.
Lateral Transmalleolar Approach to the Talus - How to reach the lateral talar dome through a fibular osteotomy — the posterolateral osteochondral lesions and lateral dome fractures that arthroscopy and arthrotomy cannot reach perpendicular, the medial malleolar osteotomy's mirror-image counterpart argued honestly, pre-drilling the fibula before the oblique osteotomy so anatomical repair is guaranteed, protecting the peroneals behind and the anterior neurovascular structures in front, the lateral ligament and syndesmotic disciplines that keep the ankle stable afterwards, and the fixation-and-union arithmetic of an osteotomy made only to be put back.
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 Calcaneus and Sustentaculum Tali - How to reach the calcaneus from its dangerous side — the sustentacular fractures, medial-wall fragments and constant-fragment fixation that only the medial window serves, the neurovascular bundle (posterior tibial artery and tibial nerve dividing into medial and lateral plantar branches) that owns this territory and the flexor hallucis longus that runs directly beneath the sustentaculum, the interval between flexor digitorum longus and the bundle, why the sustentaculum is the 'constant fragment' every calcaneal reconstruction references, combined medial-lateral strategies for complex fractures, and the small-screw fixation this dense corner of bone rewards.
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 Approaches for Interdigital (Morton) Neuroma - Procedure-specific guide to dorsal and plantar webspace exposure for interdigital nerve surgery: diagnostic confirmation, approach selection, deep transverse intermetatarsal ligament control, nerve identification, neurectomy, decompression, revision strategy, closure and rehabilitation

Sports Medicine — 3 approaches

sports-medicine (3 approaches)

Knee Arthroscopy Approach - A pathology-led operative guide to safe knee arthroscopy: patient selection, anterior and posterior portal creation, systematic examination, triangulation, complications and evidence.
Lateral Approach to the Knee: ITB, FCL and Posterolateral Corner - Operative guide to target-specific lateral-knee exposure, including iliotibial-band and Gerdy anatomy, fibular collateral ligament and posterolateral-corner dissection, common fibular nerve protection, repair and reconstruction, complications and rehabilitation.
Medial Approach to the Knee: MCL, Posteromedial Corner and Meniscus - Operative guide to target-specific medial-knee exposure, including superficial and deep MCL anatomy, posterior oblique ligament, saphenous nerve and pes protection, anatomical repair and reconstruction, posteromedial meniscal access, complications and rehabilitation.

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
Anterior Axillary-Crease Approach to the Shoulder - Surgeon-level guide to the anterior axillary-crease skin route for selected open anterior shoulder stabilisation, with full-thickness flap mobilisation to the deltopectoral interval, cephalic-vein management, subscapularis and capsular access, and protection of the musculocutaneous and axillary nerves.
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
Boyd Approach — Proximal Radius and Ulna - Consultant-level guide to the classic and modified Boyd posterolateral approach: patient selection, proximal-ulnar and radial-head exposure, posterior interosseous nerve protection, ligament-preserving dissection, fixation sequence, closure and complication rescue
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 - Operative guide to short lateral, extended anterolateral and two-window deltoid-split exposures of the proximal humerus, with direct axillary-nerve protection, fracture-specific reduction, safe plate passage and deltoid-preserving 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 pronating the forearm, capsulotomy and radial-head access, and repair of the LUCL.
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.
Lateral Approaches to the Radial Head and Neck - Surgeon-level guide to Kocher, Kaplan and EDC-splitting exposures of the radial head and neck, with LUCL preservation, posterior interosseous nerve protection, dynamic hardware placement and procedure-specific closure.
Medial (Hotchkiss Over-the-Top) Approach to the Elbow - Consultant operative guide to the anterior medial Hotchkiss over-the-top approach for coronoid-tip, anterior-capsular and selected anteromedial coronoid exposure, with anatomy-led approach selection, nerve protection, fixation strategy and stability-guided rehabilitation.
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 - Operative guide to the triceps-reflecting anconeus pedicle approach for distal-humeral fractures and nonunions: ulnar-nerve protection, modified Kocher and medial exposures, proximal reflection of the triceps-anconeus flap, dual-column fixation, transosseous triceps repair and rehabilitation
Wrightington Approach to the Radial Head - Surgeon-level guide to the true Wrightington approach: posterior radial-head exposure by subperiosteal anconeus elevation and a repairable supinator-tuberosity bone-fleck osteotomy carrying the annular and lateral ligament complex

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Approach guides.

Start with the setup

Know the danger structures

Preparation

Technique

Aftercare

Browse by operative region

Arthroplasty

Trauma

Spine

Hand & Wrist

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Shoulder & Elbow