You are on page 1of 24

1.

In a modified Hardinge (lateral) approach to the hip, what structure limits the
proximal extent of the gluteus medius split? Review Topic
QID: 3069
1.

Superior gluteal nerve

90% (657/733)

2.

Inferior gluteal nerve

8% (57/733)

3.

Pudendal nerve

0% (2/733)

4.

Corona mortis

1% (5/733)

5.

Sciatic nerve

1% (9/733)

PREFERRED RESPONSE ▶ 1
The superior gluteal nerve enters the deep surface of the gluteus medius approximately 5 cm
proximal to the tip of the greater trochanter. Splitting the muscle, as in the Hardinge
approach, has been reported to cause injury to this nerve if the split is carried above 5 cm. A
simple tag suture can be placed at this level to prevent propogation of the split inadvertently
during surgery.
2. The medial femoral circumflex artery and first perforating branch of the profunda
femoris artery anastamose at which of the following locations? Review Topic
QID: 720
1.

Medial to the gluteus medius insertion

33% (301/917)

2.

Medial to the gluteus maximus insertion

39% (355/917)

3.

Anterior to the adductor magnus

19% (177/917)

4.

Within the gluteus minimus muscle belly

2% (20/917)

5.

Medial to the ischial tuberosity

6% (58/917)

PREFERRED RESPONSE ▶ 2

The medial femoral circumflex artery is the primary blood supplier to the adult femoral head.
This artery anastamoses with the first perforating branch of the profunda femoris just medial
to the gluteus maximus insertion. This is important, as sectioning the gluteus maximus tendon
during posterior approaches can put both of these vessels (and the anastamosis) at risk.

3. Where is the origin of the muscle located between the anterior acetabulum and iliac
vessels? Review Topic
QID: 3031
1.

Anterior superior iliac spine

7% (73/984)

2.

Obturator foramen

5% (49/984)

3.

Anterior inferior iliac spine

21% (207/984)

4.

Pubic tubercle

3% (25/984)

5.

Lumbar transverse processes

63% (620/984)

PREFERRED RESPONSE ▶ 5

Tibialis posterior and flexor hallucis longus 40% (99/249) PREFERRED RESPONSE ▶ 1 The flexor digitorum longus and tibialis posterior lie on the posterior aspect of the interosseous membrane and tibia. The posterolateral approach to the tibia is useful to expose the middle two thirds of the tibia. Tibialis posterior and tibialis anterior 0% (0/249) 5.1 cm away from the iliopsoas at the level of its insertion at the lesser trochanter. Illustration A shows a cross section of the surgical approach. 4. The superficial internervous plane lies between the gastrocnemius/soleus (tibial nerve) and peroneal muscles (superficial peroneal nerve). What two muscles lie on the posterior aspect of the interosseous membrane and tibia in the lower leg. The deep dissection involves detaching FHL and soleus from the posterior border of the fibula and then dissecting medially to separate the posterior tibialis off the posterior surface of the interosseous membrane and the posterior tibialis and flexor digitorum longus off the posterior surface of the tibia. Peroneus longus and peroneus brevis 4% (9/249) 3. Peroneus brevis and peroneus tertius 3% (7/249) 4. The referenced article by Skaggs et el found that the iliac vessels were on average 1 cm away from the iliopsoas at the level of the pelvic brim. It is useful for plating of fractures and treatment of nonunions including bone grafting because it allows for soft tissue coverage of a bone that is otherwise subcutaneous. and must be elevated during a posterolateral approach to the tibia for treating a nonunion? Review Topic QID: 988 1. but could be as close as 4mm in children. Flexor digitorum longus and tibialis posterior 53% (133/249) 2. . and is often used when the anterior and anterior medial approaches are limited by skin issues. They also found that the neurovascular structures were on average 3. and this muscle originates off the transverse processes of L1-L5. Flexor hallucis longus lies on the posterior border of the fibula.The psoas muscle serves to protect the iliac vessels from retractors/instruments anterior to the acetabulum.

Just below this bifurcation.5. the common iliac vessels divide in turn at about the S1 level into the internal and external iliac vessels. L2 13% (126/935) 2. Hoppenfeld's Surgical Exposures states "The aorta divides on the anterior surface of the L4 vertebra into the two common iliac arteries. S1 0% (2/935) PREFERRED RESPONSE ▶ 3 The level of the bifurcation of the great vessels can vary. but most commonly is located at or near the L4 vertebral body. L4 68% (634/935) 4. Exposure of the L5-S1 disc space usually can be performed by working in between the bifurcation of the aorta. A vertebral body is identified directly posterior to the bifurcation of the aorta." . L3 11% (100/935) 3. L5 7% (68/935) 5. Direct anterior exposure of the L4-5 disc space usually requires lateral retraction of the great vessels. What is the most likely level of this vertebral body? Review Topic QID: 408 1. A surgeon is planning to place an anterior interbody device in the lumbar spine using a retroperitoneal approach.

An MR aortogram is shown in Figure A. The sympathetic chain can be seen running down the lateral aspect of the vertebral bodies.1%).3%). L4 = blue. The genitofemoral nerve (GFN) runs along side the psoas muscles (PM) along with the ureter which is not shown in this dissection.6%). What structure is identified by the red arrow in the coronal and axial views? Review Topic FIGURES: A QID: 875 . L2 = yellow). The bifurcation sits over the vertebral body of L4. at the fourth lumbar intervertebral disc in 23 cases (12. The lumbar segmental vessels branch from the aorta roughly at the midpoint of the vertebral bodies (L5 = magenta. Illustration A shows a cadaveric specimen. When working at L2 or above the renal arteries (LRV) must be identified.Khamanarong et al showed in a study of 197 cadavers that "the abdominal aorta descended and bifurcated into two common iliac arteries at the level of L4 vertebra in 131 cases (70. 6. and at the level of L5 vertebra in 33 cases (17. L3 = green.

1. It would not show up on an aortogram. The sympathetic chain (5) runs longitudinal along the lateral aspect of the vertebral column. segmental lumbar artery 83% (209/252) 5. sympathetic chain 1% (2/252) PREFERRED RESPONSE ▶ 4 The segmental lumbar arteries branch directly off the aorta and run anterior to posterior along the lateral border of the lumbar vertebrae. hypogastric plexus 2% (5/252) 2. or the hypogastic plexus. The anatomic course of the artery shown in Figure A is not consistent with the superior mesenteric artery. inferior mesenteric artery 8% (21/252) 4. superior mesenteric artery 6% (14/252) 3. inferior mesenteric artery. During a retroperitoneal approach to the spine it is important to identify and tie off the segmental arteries to avoid excessive bleeding. .

Ilioinguinal approach 4% (27/762) 4. Watson-Jones approach 14% (107/762) 5. superficial. rectus femoris. deep) and superior gluteal nerve (tensor fascia latae. In this approach.7. gluteus medius. The ascending branch of the lateral femoral circumflex artery runs proximally in the . Stoppa approach 2% (13/762) 2. Kocher-Langenbach approach 10% (75/762) 3. an internervous interval between the femoral nerve (sartorius. superficial. deep) is utilized. The ascending branch of the lateral femoral circumflex artery is at risk with which of the following surgical approaches? Review Topic QID: 924 1. Smith-Petersen approach 71% (539/762) PREFERRED RESPONSE ▶ 5 The ascending branch of the lateral femoral circumflex artery is at risk during the SmithPetersen approach to the hip.

Incorrect Answers Answer 1: http://www. biceps femoris 2% (6/379) 3. but should be fully exposed above and below the lesser trochanter so as not to injure the medial femoral circumflex artery.com/approaches/12016/ilioinguinal-approach-to-theacetabulum Answer 4: http://www.orthobullets. The deep plane is between adductor brevis and adductor magnus.com/approaches/12021/hip-anterolateral-approachwatson-jones 8.orthobullets. effective way to reduce a dislocated hip in infancy".orthobullets.orthobullets. the iliopsoas tendon can be released. obturator artery 5% (46/908) .com/approaches/12015/posterior-approach-to-theacetabulum-kocher-langenbeck Answer 3: http://www. Tenotomy of which muscle performed during an anteromedial approach for surgical reduction of a congenitally dislocated hip places the medial femoral circumflex artery at risk? Review Topic QID: 2829 1.internervous plane between the two deep muscles. rectus femoris 12% (44/379) 5. the iliopsoas tendon is released. obturator nerve 15% (135/908) 2. sartorius 3% (12/379) PREFERRED RESPONSE ▶ 3 Weinstein and Ponseti suggested that the anteromedial approach provides "a safe. During this approach. iliopsoas 81% (306/379) 4. Following an uneventful medial approach to the hip. Which of the following neurovascular structures is most at risk during release of the tendon? Review Topic QID: 404 1. 9. The superficial plane is between gracilis and adductor longus.com/approaches/12056/stoppa-approach-to-acetabulum Answer 2: http://www. semimembranosus 2% (9/379) 2.

it is not in the vicinity of the iliopsoas tendon. The medial femoral circumflex artery branches off the profundus femoris (~85%) or femoral artery (15%) and then wraps posterior to the iliopsoas tendon before traveling posterior to the femoral neck to supply the femoral head. While it is seen during the approach.3. Answer 2: The obturator artery lies within the pelvis. Illustration C shows the anatomy of the Medial femoral circumflex artery in relation to the iliopsoas tendon and medial approach to the hip. . found from a cadaveric study on 24 hips that the MFCA originated from the profunda femoris in 20/24 specimens. medial femoral circumflex artery 68% (618/908) 5. Gautier et al. then adductor brevis and magnus in order to arrive at the lesser trochanter. while the origin of the MFCA was the common femoral artery in 4/24 of the specimens. Illustration A and B shows the surgical plane of the medial approach to the hip as it accesses the lesser trochanter. sciatic nerve 1% (10/908) PREFERRED RESPONSE ▶ 4 The medial approach to the hip gives excellent exposure to the insertion of the psoas tendon on the lesser trochanter. femoral artery 10% (95/908) 4. psoas tendon. The medial femoral circumflex artery is at risk when performing a psoas release with this approach. and hip capsule. it is a more superficial structure and is not exposed during this approach. The medial approach to the hip involves utilizing the interval between adductor longus and gracilis. Answer 4: The sciatic nerve is a posterior structure and not seen in this exposure. Incorrect Answers: Answer 1: The obturator nerve is a more superficial structure. Answer 3: Although the femoral artery can be the origin of the MFCA.

the anterior capsule of the elbow is violated while the arthroscopic shaver is being used through an anterolateral portal. A 58-year-old female undergoes right elbow arthroscopy for loose body removal and debridement. A clinical photograph demonstrating the patients post-operative physical exam deficits is shown in Figure A.10. During the case. Which structure labeled in Figure B has most likely been damaged? Review Topic FIGURES: A B QID: 3258 .

1. Anterolateral (Watson Jones) 49% (465/955) . but loss of supinator function would not result in the clinical photograph provided. Posterior approach with posterior soft tissue repair 5% (52/955) 2. Which of the following approaches for total hip arthroplasty is reported to have the lowest prosthetic dislocation rate? Review Topic QID: 581 1. the result of a posterior interosseus nerve (PIN) palsy. 2 12% (107/886) 3. The PIN is at risk of iatrogenic damage when performing surgery on volar aspect of the proximal forearm. Injury to the superficial radial nerve (choice 2) would result in sensory deficits only. 3 75% (667/886) 4. 4 4% (32/886) 5. Injury to the radial nerve (choice 1) would result in complete loss of wrist extension. None of the identified structures have been damaged 2% (21/886) PREFERRED RESPONSE ▶ 3 The clinical photograph demonstrates loss of finger extension and partial loss of wrist extension. The PIN supplies the wrist and finger extensors with the exception of ECRL which is innervated by the radial nerve proximal to the bifurcation. The supinator (choice 4) is innervated by the PIN. 1 6% (54/886) 2. This is particularly a concern during elbow arthroscopy when working through a distally placed anterolateral portal. 11.

3. However. All of the following structures pass below the piriformis through the greater sciatic foramen EXCEPT: Review Topic QID: 268 1.23% for the posterior approach (3.95% without posterior repair and 2.43%) followed by anteroalateral (0. inferior gluteal artery 7% (50/725) PREFERRED RESPONSE ▶ 4 The pudendal nerve.55% for the direct lateral approach. The greater sciatic foramen is bounded as follows: anterolaterally by the greater sciatic notch of the illium.032) to be associated with a significantly increased odds ratio for the development of a postoperative motor nerve palsy. The article by Kwon et al found the lowest dislocation rate with direct lateral (0. the article also found that the incidence of postoperative limp was 4% to 20% for patients who had the lateral approach and 0% to 16% for patients who had the posterior approach.7%) and posterior with soft tissue repair (1. and 0. obturator nerve 62% (452/725) 5. The metanalysis by Masonis and Bourne found a dislocation rate for 14 studies involving 13000 total hips was 1.03% with posterior repair). Direct lateral (Hardinge) 43% (407/955) 4.27% for the transtrochanteric approach. pudendal nerve 20% (144/725) 2.18% for the anterolateral approach. The obturator nerve does not exit the sciatic foramen. Eight studies involving 2455 primary total hip arthroplasties evaluated postoperative limp. sciatic nerve. 2. sciatic nerve 8% (55/725) 3. Posterior approach without posterior soft tissue repair 0% (1/955) PREFERRED RESPONSE ▶ 3 The direct lateral (Hardinge) approach has been cited to have the lowest associated dislocation rate of the options provided.004 patients and found the use of a posterior approach (p = 0. 12. . and inferior gluteal artery all exit the sciatic foramen. Transtrochanteric 3% (25/955) 5. 3. inferior gluteal nerve 3% (23/725) 4. The article by Farrell et al reviewed 27.01%). inferior gluteal nerve.

inferior gluteal nerve. During a total knee arthroplasty using a standard medial parapatellar approach. nerve to obturator internus. internal pudendal vessels. sciatic nerve. Superior lateral genicular 76% (673/889) 2. and nerve to quadratus femoris. innervates the gracilis. Inferior lateral genicular 13% (119/889) . adductors (longus. posterior femoral cutaneous nerve. L3. magnus). inferiorly by the sacrospinous ligament and ischial spine. Below the piriformis the following structures exit: inferior gluteal vessels. The following structures make their exit from the pelvis through the greater sciatic foramen above the piriformis: superior gluteal vessels and superior gluteal nerve. and superiorly by the anterior sacroiliac ligament. The obturator nerve originates from the L2. if a lateral parapatellar release is required. It is partially filled up by the piriformis which leaves the pelvis through it. pudendal nerve.posteromedially by the sacrotuberous ligament. and L4 nerve roots. special attention should be made to preserve which of the following arteries? Review Topic QID: 3265 1. and provides sensation to the inferomedial thigh. brevis. 13. exits the pelvis through the obturator foramen.

Lateral to patellar tendon with knee flexed 11% (27/242) . Descending branch of lateral femoral circumflex 1% (10/889) PREFERRED RESPONSE ▶ 1 The superior lateral genicular artery is the one at greatest risk with a lateral release of the patella. When performing an aspiration or intra-articular injection in the knee. Illustration A demonstrates the anastomosis network of arteries surrounding the patella. The review article by Kelly emphasizes that the superior lateral genicular artery should be preserved when possible with the release as it may be the last extraosseous blood supply to the patella. At the site of maximal tenderness 1% (2/242) 2. the superior lateral genicular artery is likely the only remaining blood supply to the patella. Medial to patellar tendon with knee flexed 8% (19/242) 3.3. 14. After a standard medial parapatellar approach to the knee with excision of the fat pad and lateral meniscus. Resurfacing of the patella further decreases blood supply to the patella by damaging the intraosseous blood supply of the patella. Anterior recurrent tibial 3% (26/889) 4. Middle genicular 6% (57/889) 5. the most accurate needle placement site is which of the following? Review Topic QID: 955 1.

15. Lateral and posterior compartments of the leg 1% (10/844) 3. Review Topic Anterior and lateral compartments of the leg 1% (12/844) 2. Anterior and posterior compartments of the forearm 1% (9/844) PREFERRED RESPONSE ▶ 3 Hunter’s canal is also known as the adductor canal. which makes it easier to palpate the bony landmarks and evert the patella. . accuracy rates were highest for the midlateral portal (93%) compared to anteromedial (75%) or anterolateral (71%). Medial to proximal patella with knee in extension 2% (6/242) 5. Extension allows greater patellar mobility and increases the available space in the patellofemoral joint compared to flexion. evaluated 240 consecutive injections in patients without clinical knee effusion placed anteromedial. Anterior and medial compartments of the thigh 66% (554/844) 4. which runs behind the sartorius muscle. Also found in Hunter's canal are the saphenous nerve and the nerve to vastus medialis. Using fluoroscopy to confirm location. Hunter's Canal is bordered by what two muscular compartments? QID: 92 1.4. Jackson et al. the popliteal fossa. The femoral artery and vein pass through the canal enroute to the space posterior to the knee. anterolateral. Lateral to the patella with knee in extension 77% (186/242) PREFERRED RESPONSE ▶ 5 Intra-articular administration of medications has been shown to be highest with the injection performed lateral to the middle to proximal patella with the knee in extension. Medial and posterior compartments of the thigh 30% (255/844) 5. both branches of the femoral nerve. Illustration A depicts Hunter's canal with the saphenous nerve passing through it. or lateral midpatellar. A lateral starting point when injecting into the patellofemoral joint has less overlying soft tissue than medial. It is located between the anterior and medial thigh compartments.

16. Which of the following structures exits distal to the anatomic landmark identified in Figure A Review Topic FIGURES: A QID: 3136 .

1. Nerve to obturator internus 3. Nerve to obturator internus muscle 6. Internal pudendal artery Illustration A shows these structures. Piriformis muscle 2. artery. Piriformis tendon 3% (31/949) 4. Nerve to quadratus femoris 7. Tendon of obturator internus 2. and vein 5. Illustrations: A . Sciatic nerve 5% (51/949) 2. The following structures pass through the greater sciatic notch: 1. Inferior gluteal nerve and artery 4. Inferior gluteal artery 25% (234/949) 5. Internal pudendal nerve. Sciatic nerve 3. Pudendal nerve 4. Posterior cutaneous nerve of the thigh The following structures pass through the lesser sciatic nothc: 1. Superior gluteal artery 4% (34/949) 3. Obturator internus 62% (593/949) PREFERRED RESPONSE ▶ 5 The arrow points to the ischial spine and is the site of attachment of the sacrospinous ligament which anatomically divides the greater and lesser sciatic notches.

the fibers of the gluteus medius are split as are the fibers of the vastus lateralis. No true internervous plane as the dissection splits a muscle innervated by the superior gluteal nerve 81% (526/649) 5. No true internervous plane exists with this approach as the gluteus maximus is split in the line of its fibers and it is supplied by the inferior gluteal nerve. With this approach. No true internervous plane as the dissection splits a muscle innervated by the inferior gluteal nerve 9% (56/649) PREFERRED RESPONSE ▶ 4 The direct lateral approach (Hardinge) splits the fibers of the gluteus medius which is innervated by the superior gluteal nerve. The anterior approach employs the interval between the sartorius/rectus femoris (femoral nerve) and TFL/gluteus medius (superior gluteal nerve). Between femoral nerve and superior gluteal nerve 7% (47/649) 2. as this theoretically limits damage to the inferior gluteal nerve. The transverse branch of the lateral circumflex artery is often cut as the vastus lateralis is mobilized and must be cauterized during the dissection. the muscle is not typically denervated if one keeps the split less than 5cm proximal to the tip of the greater trochanter. The posterior approach utilizes the interval between the gluteus maximus (inferior gluteal nerve) and the gluteus medius (superior gluteal nerve). 18. Which of the following choices correctly identifies structures A. Between superior gluteal nerve and inferior gluteal nerve 2% (13/649) 3.17. B. and C in Figure A? Review Topic FIGURES: A . After incising the fascia lata. there is no true internervous plane. Figure A is a cadaver specimen where a posterior approach to the hip has been performed after removal of part of the Gluteus maximus muscle. However. Which of the following describes the internervous plane of the direct lateral approach to the hip? Review Topic QID: 1342 1. Between superior gluteal nerve and sciatic nerve 1% (6/649) 4.

C: Sacrotuberous ligament 3% (25/967) 5. A: Gluteus minimus. B: Piriformis tendon. C: Sacrotuberous ligament 2% (15/967) PREFERRED RESPONSE ▶ 3 In Figure A. C: Sacrotuberous ligament 58% (558/967) 4. C: Sacrospinous ligament 37% (354/967) 2. Illustrations B and C demonstrate the relationship of the ischial spine and ischial tuberosity in relation to the hip joint and the associated ligaments. B: Superior gemellus tendon. B: Piriformis tendon. The superior gemellus originates from the ischial spine .QID: 3689 1. A: Gluteus minimus. B: Quadratus femorus tendon. These are all important landmarks and points of identification during a posterior approach to the hip. B is pointing to the tendon of the piriformis muscle. A: Piriformis tendon. and C is pointing to the sacrotuberous ligament (Illustration A). A: Piriformis tendon. B: Superior gemellus tendon. C: Sacrospinous ligament 1% (12/967) 3. the arrow labeled A is pointing to the Gluteus minimus muscle. A: Gluteus minimus.

A 34-year-old female sustains a pilon fracture after jumping from a ledge.19. Which of the following nerves is MOST at risk during an anterolateral incision and exposure of the fracture as indicated by the arrow in Figure A? Review Topic FIGURES: A . An anterolateral approach is used to obtain plate fixation as shown in Figure A.

the anterior talar dome.The posterior tibial nerve is not at risk. Herscovici et al describe the Bohler incision which is an expansile anterolateral approach to the foot and ankle. They found that the superficial peroneal nerve (SPN) is always seen in the distal incision and should be safe if adequately protected. but is on the fascia over the anterior compartment at the level of the ankle. This surgical dissection crosses the anterior compartment of the leg. and calcaneocuboid joints. 5. Posterior tibial nerve in the deep posterior compartment 0% (0/633) PREFERRED RESPONSE ▶ 2 The deep peroneal nerve is at risk during an anterolateral approach to the distal tibia and ankle for open reduction and internal fixation of pilon fractures. The anterolateral approach to the distal tibia is a commonly used approach for ORIF of distal tibia and ankle fractures. Incorrect answers: 1. Saphenous nerve in the superficial posterior compartment 2% (13/633) 5.The superficial personeal nerve is also at risk during this incision. 3. The superficial peroneal nerve (SPN) is superficial to the fascia at the level of the ankle. endangering the deep peroneal nerve (DPN).The saphenous nerve is not at risk. Superficial peroneal nerve in the anterior compartment 34% (218/633) 2. subtalar. talonavicular. They describe its utility in exposure of the anterior surface of the distal tibia. Sural nerve in the superficial posterior compartment 2% (10/633) 4. . talar neck. Wolinsky et al performed an anatomical study on the anterolateral approach to the distal tibia. The structures at risk with this approach are the DPN and the anterior tibial vessels as they course from a posterior position proximally to a more anterior position distally.QID: 3429 1.The sural nerve is not at risk. Deep peroneal nerve in the anterior compartment 62% (391/633) 3. 4.

20. Horner’s Syndrome classically presents with 1. Pupillary dilation and hyperhidrosis on the patient's right side 1% (3/296) 2. A myelopathic patient undergoes anterior cervical diskectomy and fusion through a left sided approach. Pupillary constriction and anhidrosis on the patient's left side 91% (270/296) 5. Pupillary constriction and anhidrosis on the patient's right side 3% (9/296) PREFERRED RESPONSE ▶ 4 The patient has a left-sided Horner's syndrome which would be characterized by ptosis. ipsilateral miosis (pupillary constriction caused by injury to long ciliary nerve to pupil dilator) and 3. These muscles lie anterolaterally to the cervical vertebral bodies. pupillary constriction and anhidrosis on the patient's left side Horner's syndrome is a rare but known complication of anterior approaches to the cervical spine. A clinical photo is shown in Figure A. Horner's Syndrome is caused by an injury to the cervical sympathetic ganglia/trunk. Pupillary constriction and hyperhidrosis on the patient's right side 1% (3/296) 4. ipsilateral ptosis (drooping eyelid caused by injury to nerve to Muller’s muscle) 2. usually (but not always) ipsilateral anhidrosis. Facial asymmetry is noticed postoperatively in the recovery room. What additional finding would likely be found on physical exam? Review Topic FIGURES: A QID: 232 1. which are located anterolaterally to the longus colli and longus capitis muscles. Injury to the nerves can occur either during dissection or with aggressive (injudicious) retraction during an anterior approach to either side of the cervical spine. It has been postulated that this complication can be avoided if subperiosteal dissection of the longus colli muscles is performed. . Pupillary dilation and hyperhidrosis on the patient's left side 3% (8/296) 3.

which observed in 9. Figure A shows a patient with left sided Horner's Syndrome. Illustration A depicts the anatomic location of the sympathetic chain in relation to the vertebral bodies. Femoral vessels 2% (37/1545) . investigated complications associated with anterior cervical discectomy and fusion (ACDF).Fountas et al. The most common complication was the development of isolated postoperative dysphagia. ligation of the anastamoses between the obturator vessels and which of the following vessels should be performed to gain appropriate access to the true pelvis? Review Topic QID: 4747 1. Illustrations: A 21. They found the incidence of Horner's syndrome was 0. looked at complications of anterior cervical discectomy without fusion (ACD) in 450 consecutive patients.6%.1% of patients.5% of patients. Wound infection developed in 1. They reported an incidence of Horner's syndrome in 1. Notice the drooping eyelid and pupillary constriction on the left relative to the right hand side. External iliac vessels 71% (1104/1545) 2.1% (1 of 1140)in patients undergoing first-time ACDF for cervical radiculopathy and/or myelopathy. When performing an anterior intrapelvic approach to the acetabulum. Bertalanffy et al. Superior gluteal vessels 4% (66/1545) 4. Internal iliac vessels 19% (299/1545) 3.

They found that an anastomoses between the obturator and external iliac systems occurred in 84% of the specimens.5. requires ligation of the corona mortis (defined as the vascular connections between the obturator and external iliac systems) to gain visualization laterally and into the true pelvis. and technique for the Stoppa approach to the pelvis. Thirty-four percent had an arterial connection. Incorrect Answers: Answers 2-5: These do not typically anastomose with the obturator vessels. They state that these vessels must be ligated or clipped to advance the dissection further along the pelvic brim and quadrilateral surface. performed a cadaveric dissection to determine the occurrence and location of the corona mortis. Archdeacon et al. The name "corona mortis" or crown of death testifies to the importance of this feature. discuss the indications. Femoral cutaneous vessels 2% (32/1545) PREFERRED RESPONSE ▶ 1 The Stoppa. Illustrations: A . Illustration A shows the corona mortis as an anastomoses between the obturator and external iliac vascular systems. 70% had a venous connection. The corona mortis is located behind the superior pubic ramus at a variable distance from the symphysis pubis. as significant hemorrhage may occur if inadvertently cut and it is difficult to achieve subsequent hemostasis. and 20% had both. or anterior intrapelvic approach. They state that the vascular anastomoses between the external iliac and obturator vessels are encountered as the artery and vein course over the superior ramus traveling toward the obturator foramen. set-up. Tornetta et al.