By Claude D. Jarrett, MD

In golf, focusing and mastering a good approach shot can considerably ease the difficulty of the putt.  One of the quickest ways to worsen one’s score is to rush through an approach shot while prematurely thinking about putting on the green.  Similarly as my fellowship mentor constantly reminded me, one of the most common operative mistakes is rushing through the approach.  The exposure often remains the most beautiful and exhilarating aspect of upper extremity surgery.  Prematurely focusing on “the procedure” and glossing over the exposure can elevate the difficult of the ultimate task as well as increase the risk for complications.

During fracture repair, the technically sound surgical exposure can, at times, account for as much operative time as reduction and fixation of the fracture.  Difficult or unacceptable reduction is often the result of inadequate exposure.  One cannot fix what one cannot see.  A large percentage of my preoperative planning routinely involve detail focus on local, distance, level, and potential hazards of the chosen approach. Many surgical exposures will directly or indirectly facilitate fracture fragment mobilization.  In some fortunate cases, following a good exposure the fracture may actually reduce itself.

In the setting of joint arthroplasty, the surgical approach and exposure can involve mobilization and safe handling of adjacent neurovascular structures.  Each layer of the exposure is important and must be performed with meticulous care.  Gentle handling of the superficial soft tissue, discriminating deep fascial planes, and mobilization of the soft tissue envelope will allow optimal implant positioning and fixation as well as improve balancing opposing musculotendinous constraints.

A well thought through and carefully performed approach will place the ball with a great lie for an easy putt. Let’s remember to focus on and enjoy the approach shot.