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When using the medial approach to the knee, as in repair of medial compartment structures, knowledge of the location of the sartorial nerve is important in order to avoid postoperative distress caused by division of this nerve. We studied the locations of the sartorial nerve in 23 cadavers, with particular reference to the relationship with the pes anserinus and the nerve's distance from the medial femoral epicondyle. The average distance between the sartorial nerve at its emergence and the central point of the medial femoral epicondyle was 34.02 mm, with a range of 20.7 to 49.8 mm on the right lower limb, and 33.27 mm, with a range of 20.0 to 49.2 mm, on the left lower limb.

Twenty-two patients with 22 displaced intraarticular fractures of the calcaneus were treated by open reduction and internal fixation using a lateral approach and, when needed, a medial approach, followed by early motion. These patients were evaluated from 16 to 72 months (average, 37 months) after surgery. At follow-up evaluation, the result was assessed on the basis of restoration of anatomy and function. Combining the anatomic and functional findings, the results in this series were good in 17 patients, fair in one, and poor in four.

An ankle arthrodesis was done on twenty-five patients, using a specially designed T-plate. The T-plate provides a compressive force across the ankle of approximately 18.5 newtons per square meter and is most often applied through a medial approach to the ankle joint. This new approach provides excellent exposure and supplementary bone graft, and facilitates alignment of the ankle and foot in a neutral position. A successful arthrodesis was obtained in each patient. In the thirteen patients for whom a functional rating could be obtained, the average preoperative score of 47 points improved to an average postoperative score of 82 points.

From January 1970 to December 1976, seventeen patients with twenty-two congenital hip dislocations were treated by open reduction through a medial approach. The average follow-up was 42.2 months. The patients were evaluated for acetabular development, aseptic necrosis, and intraoperative findings. The incidence of aseptic necrosis was 10 per cent. The acetabular index improved rapidly during the first year after reduction. After the first year the rate of development was decreased, but the acetabular index continued to improve throughout the period of study. The medial approach provides a safe, effective way to reduce a dislocated hip in infancy. This procedure is advocated when closed reduction cannot be obtained by gentle manipulation or maintained by positioning once reduction is done.

Between 1974 and 1982, 56 hips of 51 children with congenital hip dislocation were treated by open reduction via the medial approach according to Ferguson. The mean age at operation was 7 (3-15) months. After 4 months of plaster cast immobilization, 41 hips had a normal acetabular index. Three hips required supplementary surgery: Salter's pelvic osteotomy in one case and a varus osteotomy in two cases. Of the remaining 53 hips, 26 received supplementary abduction treatment. During the first 2 years after reduction, 19 hips showed slight lateral displacement due to capsular laxity. The follow-up averaged 3 (0.5-8) years. All children older than 3 years now had stable, concentrically reduced hips without special treatment of the lateralization; in 9 of the 56 hips the acetabular roof was still dysplastic at follow-up. There was no difference in anteversion and neck-shaft angle between the treated and the contralateral hips. As vascular lesions were observed in only two hips and lateralization disappeared spontaneously, the Ferguson procedure seems safe.

From a review of 131 children with arthrogryposis, we studied 18 patients with hip dislocations. Fourteen patients (10 unilateral, four bilateral) were treated by open reduction. Mean age at surgery was 9.7 months, and follow-up ranged from 9 to 245 months. Range of motion of patients treated by open reduction following the medial approach was greater than in those treated by anterolateral incision and greater than in bilateral cases treated by closed reduction. Acetabular development was satisfactory following the medial approach and there were no re-dislocations, but one hip developed avascular necrosis.

Twenty-two displaced intra-articular fractures of the calcaneus (in twenty-two patients) were treated by open reduction and internal fixation with a screw and one or two staples using a lateral and, when needed, a medial approach, followed by early motion. Despite the early motion, a nearly normal anatomical reduction was achieved and maintained in nineteen feet. After follow-up that ranged in duration from sixteen to seventy-two months, the clinical and radiographic result was rated as good in seventeen patients and fair in one, and there were four failures. Twenty-one of the twenty-two patients returned to work within six months. The average subtalar motion at follow-up was 75 per cent of normal.

The case details of ten dogs with osteochondritis dissecans of the medial condyle of the humerus and seven dogs with ununited coronoid process are presented. Seventeen dogs were treated surgically and the medial approach to the elbow is described.

The fractured calcaneus is an enigma to many orthopedic surgeons. Because of this they are often not reduced as well as they might be. The majority of these fractures can be adequately reduced by the medial approach. This approach is based on the fact that a definite pattern of fracture occurs on the medial side of the calcaneus, whereas there is no pattern on the lateral side. If one restores the medial wall of the calcaneus, which is most accurately done from the medial side, the height, length, and much of the width is restored. Strong pressure over the lateral bulge is necessary to completely restore normal width. Generally, the tongue or joint depression-type fragments can be reduced from the medial side. If not, a separate, lateral incision is used to insure their reduction. The neurovascular bundle is no longer dissected out, removing a psychological barrier to the medial approach. A strong recommendation is made to use the longitudinal pin method of fixation. It is simple, and extremely strong. A classification of calcaneus fractures is presented, which can help in preoperative planning for reduction of these fractures.

Based on dissections of the hips of four stillborn infants and observations during open reductions, a procedure to release the tight iliopsoas tendon and capsule through a medial approach was developed and applied in thirty infants two weeks to two years old. After this procedure, easy reduction without compression or constriction of the femoral head and immobilization in a functional position was possible. All hips so treated and immobilized for four months postoperatively showed no evidence of any growth disturbance and rapidly regained a full range of motion.

Introduction Developmental dysplasia of the hip (DDH) is one of the most commonly diagnosed and treated paediatric orthopaedic conditions. Objective To systematically identify, appraise and synthesise the best evidence for the long-term outcomes of the medial approach open reduction (MAOR) for DDH. Methods MEDLINE, EMBASE and the Cochrane databases were searched up to July 2013. All study designs that reported on the long-term outcomes of the MAOR as the primary treatment modality for DDH were included. The risk of bias in each study was evaluated using the Cochrane risk of bias assessment tool with some modification to accommodate different study designs. Results From the 162 citations screened, five retrospective observational studies that fulfilled the eligibility criteria were included. The mean age at surgery varied from 10 to 17 months with an average follow-up period of 16–25 years. Acetabular development, as defined by the Severin Classification, was reported as satisfactory (Severin I/II) in between 38 and 79 % of study cohorts. However these good and excellent outcomes were less promising when patients who had additional operations were considered as unsatisfactory results. Avascular necrosis, as predominantly defined by the Kalamchi criteria, varied from 5 to 43 %. Negative prognostic factors implicated were mean age at surgery >17 months, the absence of the ossific nucleus and eccentric posturing of the femoral head postoperatively. The rate of secondary operations reported varied from 11 to 50 %. There were no reported total hip replacements. Conclusion There is a paucity of robust evidence pertaining to the long-term outcomes of the MAOR for developmental dysplasia of the hip. The trends from observational studies suggest that the long-term outcomes are not as positive as short- to intermediate-term studies suggest. Further prospective, controlled and rigorously designed studies are required to validate this approach.

An 11-year-old girl with osteoid osteoma of the medial femoral neck underwent excision of the lesion through a medial adductor approach. A satisfactory result was achieved without unsightly scarring or internal fixation. The medial adductor approach should be considered when osteoid osteoma of the femoral neck is encountered.

The standard approach is from the left side to avoid the recurrent laryngeal nerve. Rotate the head to the right and inflate the cervical pillow to support the head and neck. The necessity for intraoperative traction is determined by the pathologic lesion. When necessary use Gardner Wells tong traction, rather than the halter.

This technique allows wide access to the entire popliteal artery by detaching the tendons of the pes anserinus and semimembranosus muscles, without any muscular division. The tendons are reinserted anatomically upon completion of the vascular procedure. This technique was used in 14 patients, without complication. This technique is of particular value when it is necessary to inspect the popliteal artery to determine the etiology of the occlusion in the young subject. It is invaluable when direct access to the midpopliteal artery is required.

Decompression of the orbit by a medial approach was first suggested by Sewall (1936) but only isolated cases in which the technique had been used for the relief of endocrine exophthalmos were reported (Kistmer, 1939; Schall & Reagan, 1945; Spencer Harrison, 1956; Boyden, 1956) until Smith (1972, 1975) reported the results in 15 cases. The present paper relates further experience with the operation. For the first time some degree of statistical analysis of the results is possible.

Thyroidectomy initiated by transecting the isthmus and peeling the lobes laterally away from the midline exposes the three vital elements of thyroid anatomy, namely the vessels, the recurrent laryngeal nerves and the parathyroid glands, by an almost bloodless dissection conducted at a distance from these vital structures. Part or all of the lobe or lobes can be removed while the parathyroid glands and recurrent laryngeal nerves remain clearly under view at all times.

This paper describes a prosection of the pterygomandibular space from a medial perspective, as the dentist would encounter it. The prosection is performed on a bisected head, with vertebrae removed. The preparation can be used to demonstrate to the student the exact course of a needle during an inferior alveolar nerve block. The anatomical structures involved in performing the conventional, Gow-Gates, or Akinosi injection techniques are directly compared. The impingement of a misplaced needle on neighboring structures can be demonstrated.

The operative findings and results in our first 40 consecutive open reductions of the congenitally dislocated hip by the medial approach are presented. These were all performed by one surgeon before walking age and, with one exception, all patients were aged less than 11 months at operation. Follow-up was from 2 to 7 years (mean 4.6 years). A vascular necrosis did not occur, but coxa magna and significant acetabular dysplasia were each present in one case. We have not performed any secondary operations.

Background Plate fixation is the gold standard for diaphyseal fracture management, and the anterolateral approach is widely used by reconstructive surgeons. However, the outcomes of humeral shaft fracture fixation using a medial approach are rarely reported. The aim of this study is to explore the management and outcomes of humeral mid-shaft fractures fixed through a medial incision. Methods Thirty-four patients who sustained a humeral mid-shaft fracture and underwent an open-reduction internal fixation (ORIF) in our department between January 2010 and January 2013 were included in this study. Sixteen patients had an ORIF performed through a medial approach, while the remaining 18 were fixed through an anterolateral approach. Postoperative clinical and radiographic results were reviewed. Results There were no significant differences in the blood loss and the range of motion of the shoulder and elbow between the anterolateral and medial fixation groups. One patient in the medial group and two patients in the anterolateral group had radial nerve dysfunction that improved after 8, 3 and 6 weeks, respectively. All patients healed radiographically except one from the anterolateral group who underwent grafting and re-fixation for a non-union. No vascular injuries, infections, malunions, broken plates or loose screws were noted in either group. Conclusions The medial approach to the humerus had equivalent outcomes to anterolateral fixation. It is an available choice for humeral mid-shaft fracture fixation in cases where there is no need to expose the radial nerve. The medial approach does not require a pre-bent plate and creates a large operative exposure. A well-hidden incision can also be designed, improving cosmetic outcomes. However, the medial approach is not suitable to proximal or distal humerus fractures.

In a retrospective clinical review of patients with congenital dislocation of the hip who underwent open reduction through the Ludloff medial approach, stability of reduction, acetabular development and presence of avascular necrosis were evaluated in 11 patients with 15 dislocated hips. This approach was reserved for patients younger than 18 months of age in whom closed reduction had failed. Ten patients with 14 hips underwent preoperative traction. All 15 hips at follow-up or just prior to subsequent surgery displayed dysplastic and insufficient acetabular development, with persistent subluxation in nine hips. Subsequent surgery to obtain better concentric reduction and acetabular coverage was performed in six hips, and further surgery is being considered in four other hips. Ten hips showed signs of avascular necrosis of the ossific nucleus, with additional involvement of the growth plate in four hips. The medial approach resulted in inadequate concentric reduction, with a high incidence of avascular necrosis. In the majority of patients in this small series, a secondary procedure was needed to improve hip stability and the acetabular dysplasia.

One hundred forty-six arthrograms were performed in 130 children. Forty-two studies were bilateral, constituting a total of 188 injected hips. The majority of the studies were done for congenital dislocation of the hip, Legg-Calve-Perthes disease and septic pyarthrosis. Using the medial approach and fluoroscopic control, only three attempts were unsuccessful. None of the hips which were subsequently explored surgically showed ill effects from the injection. The addition of simulated weight-bearing and abducted and internally rotated views provides more accurate information in determining adequacy of femoral head containment.

Most calcaneal fractures are of the joint depression type or the tongue type, both of which are amenable to reduction by the medial approach technique. This procedure is based on the principle of restoring the medial wall of the calcaneus, which must be done from the medial side. An accurate reduction produces stability, restores length and height, and partially restores width. The joint depression- or tongue-type fragment is reduced to restore the articular surface of the posterior facet. Many of these fractures can be reduced from the medial side. However, if necessary, a lateral incision should also be made for accurate replacement of these fragments. The final restoration of calcaneal width is accomplished by reducing the lateral bulge of the tuberosity by applying direct pressure over the lateral heel. This deformity, which produces morbidity, must be completely reduced. The medial approach technique offers an opportunity to reduce each of the deformities of the depressed calcaneal fracture. The method is recommended.