Anatomy Flashcards
3 windows of ilioinguinal approach
Medial window
medial to external iliac artery & vein
Middle window
between external iliac vessels and the iliopsosas
Lateral window
lateral to iliopsoas (iliopectineal fascia)
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T1 dermatome/myotome
Finger abduction (interossei - ulnar n)
Sensory: medial elbow
What do the AIN & median nerve proper innervate in the forearm?
Median nerve proper
Superficial group:
PT
FCR
PL
Intermediate group:
FDS
AIN
Deep Group
FPL
FDP (radial 2)
PQ
Name the structures attached to the 3 arrows
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Top: Gluteus minimus
Middle: Piriformis
Bottom: Sacrotuberous ligament
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Name the following strucutres
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1: anterior compartment
2: tib ant
3: tibia
4: EDL
5: deep peroneal & tibial vessels
6: lateral compartment
7: peroneus longus
8: superficial peroneal nerve
9: fibula
10: tib post
11: FDL (comes off tibia)
12: FHL (comes off fibula)
13: peroneal vessels
14: tibial nerve and posterior tibial vessels
15: deep posterior compartment
16: soleus
17: long saphenous vein
18: superficial posterior compartment
19: Lateral head of gastrocnemius
20: medial head of gastroc
21: sural nerve and lesser saphenous vein
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pediatric femoral shaft fracture reduction criteria
<10 degrees varus/valgus
<20 degrees AP
<2cm shortening
<10 degrees rotational alignment
Roots contributing to the femoral nerve
L2-L4
Describe course of obturator internus
origin
Path
Insertion
Origin: ischiopubic ramus & obturator membrane
Path:
THrough lesser sciatic notch
makes a 90 degree turn
Insertion: Medial aspect of GT
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NAME THE ANATOMICAL STRUCTURES
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Course of the radial nerve, hitting salient points
From posterior cord
Travels in poseterior aspect of axilla
Through triangular interval with profunda brachii artery
In the spiral groove 14-15cm proximal to lateral epicondyle
Exit the lateral intermuscular septum never less than 7.5cm from distal articular surface
Travels between brachialis & brachioradialis anterior to lateral epicondyle
Divides into SRN and PIN at level of radiocapitellar joint
Internervous plane of Smith-Peterson approach to hip
Anterior approach:
Femoral nerve & Superior gluteal nerve
Superficial:
Sartorius (femoral)
TFL (superior gluteal)
Deep:
Rectus femoris (femoral)
Gluteus medius (superior gluteal)
Roots contributing to LFCN?
L2-3
Name the structures
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Explain the relation of the zone of calcification to physeal fractures.
The zone of Hypertrophic zone is divided into three layers, and the zone of calcification is the firsthest away from the resting zone.
This is where apoptosis happens - making it relatively weak and pre-disposes to injury.
Most fractures are through the zone fo calcification, which is good because it is far from the reserve zone which is protective against growth arrests.
Roots contributing to Sciatic nerve
L4-S3
In pelvic surgery, what adjunct do you need before cutting?
Foley to decompress bladder
Stoppa approach: 4 dangers
Bladder
Corona mortis
External iliac vessels
Obturator nerve & vessels
name the structures
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- Cephalic vein
- FCR
- FDS
- ulnar artery
- ulnar nerve
- FCU
- FDP
- basilic vein
- ulnar shaft
- APL
- PIN
- ECU
- EDM
- Supinator
- FPL
- Radial shaft
- deep branch of radial nerve
- EDC
- ECRB
- ECRL
- BR
- Superficial radial nerve
- PT
- radial artery
- median nerve
- volar (flexors)
- Dorsal (extensors)
- mobile wad
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Reduction criteria for paediatric radial neck fractures
<30 degrees angulated
<3-4mm translated
>45 degrees pro-supination
Course of the ulnar nerve
From medial cord
Runs in anterior compartment of arm, posteromedial to brachial artery
Pierces medial intermuscular septum at arcade of struthers ~8cm from the medial epicondyle, lying medial to triceps
Run behind medial epicondyle with superior ulnar collateral artery
Entes cubital tunnel
Enters forearm between 2 heads of FCU
Runs between FCU & FDP
In the wrist & had via Guyon’s canal
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What is the corona mortis and where is it located?
Anastomosis between:
external iliac system or deep inferior epigastric artery
&
obturator system
Lives in the latearl 1/3 of the pubc ramus
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C5 myotome & dermatome
Shoulder abduction (deltoid)
Elbow flexion (palm up) (biceps)
Sensory: lateral arm below deltoid
Reduction criteria for paediatric proximal humerus fracture
>50% apposition
<45 degrees angulated
No head split
Neer-Horwitz 1 or 2
C8 myo/dermatome
Finger flexion (FDS)
Sensory: 5th finger
Name the structures
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- anterior compartment
- EDL
- EHL
4: TA
5> deep peroneal nerve and tib ant vessels
- lateral compartment
- superficial peroneal nerve
- peroneus longus (lateral to brevis - protects it)
- peroneus brevis
- deep posterior copmartment
- Tib post
- FHL
- FDL
- peroneal vessels
- tibial nerve and posterio tibial vessels
- long saphenous vein
- superficial posterior compartment
- Soleus
- Achilles tendon
- Sural nerve & lesser saphenous vein
- Fibula
- tibia
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What leads you to the popliteal fossa during a posterior approach to the knee?
Medial sural cutaneous nerve
C7 myo/dermatome
Elbow extension (Triceps)
wrist flexion (FCR)
Sensory: Fingers 2,3,4
Course of median nerve
From medial & lateral cords
Travels in anterior compartment of arm with brachial artery, lateral to it in the arm, medial to it at the elbow
No branches in arm
Enters forearm between PT and biceps
Travels beween FDS and FDP
Emerges between FDS and FPL
Enters hand via carpal tunnel
L2, 3 dermatome/myotome
Hip flexion (iliopsoas)
Hip adduction (hip adductors)
Knee extension (quad)
Sensory: anterior and inner thigh
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Acceptable reduction criteria: tibial shaft
5 degrees varus/valgus
10 deg AP
50% cortical apposition
<1cm shortening
<10 degres rotational
(5, 50, 1, 10, 10)
name the structures
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What vessel must you ligate to prevent bleeding in anterior approach to the hip?
ascending branch of lateral femoral circumflex artery
L4 myo/dermatome
Knee extension (quad)
Ankle dorsiflexion (TA)
Sensory: lateral thigh, anterior knee and medial leg
Patellar reflex
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S3,4 derm/myotome
Bladder & bowel function
“S2-3-4 keep the shit off the floor”
Sensation perianal
name the structures
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- intermedial dorsal cutaneous branch of SPN
- medial dorsal cutaneous branch of SPN
- peroneus tertius
4 EDL
- EHL
- deep peroneal nerve
- tib ant
- great saphenous vein
9 tibia
- tib post
- FDL
- tibial nerve and posterior tibial vessels
- FHL
- achilles tendon
- sural nerve and lesser saph vein
- peroneus brevis
- peroneus longus
- fibula
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Name the branhces of the axillary artery
Sixties Teens Love Sex And Pot
Supreme Thoracic
Thoracoacromial trunk
Lateral thoracic artery (beside ribs)
Subscapular artery (gives of thoracodorsal & circumflex scapular)
Anterior humeral circumflex artery (will have branches ascending proximally)
Posterior humeral circumflex artery (the big one)
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Where does the ulnar nerve lie in Guyon’s canal?
Ulnar to hook of hamate
radial to pisiform
(b/c its between these two inside the canal)
Ulnar to ulnar artery
(goes nerve, artery, palmaris, ulnar –> radial)
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C6 myotome & dermatome
Elbow flexion (thumb up) (brachioradialis)
Wrist extension (ECRL)
Sensory: thumb & radial hand
S2 derm/myotome
Toe plantar flexion (FHL, FDL)
Sensation: plantar foot
L5 derma/myotome
Ankle dorsiflexion (also L4)
Foot inversion (TP)
Great toe dorsiflexion (EHL)
Hip extension (hamstrings, glut max)
Hip abduction (glut medius)
Sesory: lateral leg and dorsal foot
Humeral shaft (adult) reduction criteria
<20 AP
30 varus/valgus
<3cm shortening
Name the structures
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What structures exit through the lesser sciatic notch? (4)
The following structures pass through the lesser sciatic nothc:
- Tendon of obturator internus
- Nerve to obturator internus
- Pudendal nerve (goes through both greater & lesser))
- Internal pudendal artery (goes through both greater & lesser)
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What structures exit through the greater sciatic notch? (8)
The following structures pass through the greater sciatic notch:
Piriformis
Superior gluteal vessels and nerves
Inferior gluteal vessels and nerves
Sciatic nerve
Posterior femoral cutaneous nerve
Internal pudendal vessels
Pudendal nerve
Neve to obturator internus
Nerve to quadratus femoris
2 distinct and major complications from extended iliofemoral approach:
permanent abductor weakness
Highest rate of HO
(both b/c you strip off the entire musculature from the outer table)
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L1 dermatome
iliac crest & Groin
Medial approach to hip:
What is the danger when you’re releasing iliopsoas?
Medial femoral circumflex artery
Must directly visualize
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S1 derm/myotome
Foot plantar flexion (gastroc-soleus)
Foot eversion (Peroneals)
Sensation: posterior leg
Reflex: Achilles
Boundaries of the greater sciatic notch?
anterolaterally by the greater sciatic notch of the ilium
posteromedially by the sacrotuberous ligament
inferiorly by the sacrospinous ligament and the ischial spine
superiorly by the anterior sacroilliac ligament
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What are the four phases of a direct insertion of a tendon onto bone?
4 distinct phases:
1) ligament
2) fibrocartilage
3) mineralized fibrocartilage
4) bone
(Indirect attachment is Ligament –> Periosteum)
Medial femoral circumflex artery travels anterior to all SERs except:
Obturator externus
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Signs of sacral dysmorphism
Lumbarization of S1
Sacralization of L5
Mammilary bodies
Unfused intervertebral discs
Tongue in groove sign
Recessed sacral ala
Irregular neural foramen
Increased sacral height: should normally be below level of iliac brim
Acute alar slope
What must you do before doing a psoas tendon release from the medial approach?
Isolate and protect the MFCA that runs directly on top of psoas