THE THIGH. 519 



Anterior Operations. Liicke made an incision from just below the anterior 

 superior spine running downward and inward along the inner margin of the sar- 

 torius. The sartorius and rectus muscles were displaced outward and the iliopsoas 

 inward. 



Hiiter, Parker, and Barker made the incision directly downward from the anterior 

 superior spine and pulled the sartorius and rectus inward and the tensor fasciae 

 femoris and gluteus medius and minimus outward (Fig. 528). 



The method of Hiiter, Parker, and Barker, is not difficult. The only vessel 

 encountered is a branch of the external circumflex. One should not go too low, 

 or some muscular branches of nerves going to the vastus externus will be wounded. 

 No muscles are divided. The writer has used this method with satisfaction in cases 

 of hip disease and intracapsular fracture. 



If additional room is desired the fascia lata may be divided laterally and the 

 tensor fasciae femoris and gluteus medius muscles may be detached from the spine 

 of the ilium and back along the crest, as done by Codivilla. They are to be again 

 sewed back into place before closing the wound. 



Inferior Operations. Ludlof, in congenital luxations, abducted the thigh to 

 a right angle and made his incision along the tendon of the adductor longus. This 



Sartorius 

 Rectus 



/ Anterior inferior spine 



^ 'Anterior superior 



**; spine 



-Head of femur 



Tensor fasciae 

 femoris 



Small branches of 

 deep external cir- 

 cumflex artery and 

 nerves 

 Vastus externus 



Gluteus medius 



Gluteus 

 minimus 



Neck of femur 



FIG. 528. Anterior operation on the hip-joint. 



muscle was then drawn downward and the pectineus upward and the joint exposed. 

 The writer prefers to make an incision along the inner side of the femoral vein. The 

 vessels are then to be drawn upward and outward and the pectineus downward and 

 inward and the capsule is at once evident. 



THE THIGH. 



STRUCTURE. 



The thigh is composed of the femur imbedded in three main sets of muscles, 

 and is supplied and traversed by the femoral vessels and sciatic and anterior crural 

 nerves. 



The femur serves as a support and keeps the knee out away from the trunk. 



The muscles move the thigh on the trunk, or vice versa, and the leg on the 

 thigh. 



The blood-vessels and nerves not only supply the structures of the thigh itself, 

 but also serve as channels for the transmission of blood and nervous impulses to and 

 from the parts beyond, hence their large size. 



