Hip Surgical Access and Nerve Blocks

(At any time you can rotate the image or add or subtract structures. Clicking the link will always bring you back to a starting point. Remember to use rollovers to see the labels for the various structures. Also, by moving the axial plane to any point in the image on the right, you can see the cross-section on the lower left. Any coloration in the right image will be shown in the cross-sections.)

Anterior Hip

Bony landmarks for obturator, femoral and lateral femoral cutaneous nerve blocks. Note the inguinal ligament between the anterior, superior iliac spine and the pubic tubercle. Imagine a line parallel and 2.5 cm inferior to this ligament.

Surgical approach to the hip: Finding internervous planes between the femoral and gluteal nerves:

Anatomical exploration

Posterior Hip

Bony landmarks for sciatic nerve block. Draw a line from the posterior superior iliac spine to the greater trochanter. From the midpoint of this line, draw a perpendicular line 5 cm in the inferiomedial direction. If you can, confirm this location by drawing a line from the greater trochanter to the sacral hiatus (just below the last posterior spine of the sacrum). The midpoint of this latter line should indicate the same location.

Surgical approach to the hip