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MRCS Part B > Anatomy - Lower Limb > Flashcards

Anatomy - Lower Limb Flashcards

1
Q

What is the Garden Classification of Hip fractures?

A

Classification for intracapsular hip fractures

1 - undisplaced and incomplete
2 - undisplaced and complete
3 - slightly displaced and complete
4 - fully displaced and complete

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2
Q

Describe the anatomy of the hip capsule

A

Originates from the rim of the acetabulum proximally

Anteriorly attaches to the intertrochanteric line

Posteriorly attaches 1cm above the intertrochanteric crest

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3
Q

What are the 3 ligaments of the hip joint?

A

Iliofemoral (strongest)
Pubofemoral
Ischiofemoral

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4
Q

Blood supply to the femoral head

A

Retinacular branches of the extracapsular arterial anastamosis formed from the medial and lateral circumflex femoral arteries, retrograde supply from the profunda femoris artery (also small contributions from superior and inferior gluteal arteries)

Minor supply via artery of ligamentum teres (from obturator artery) - negligible in adults

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5
Q

Which muscles attach on to the lesser trochanter?

A

Iliacus and Psoas Major

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6
Q

Action: Psoas Major

A

Flex and externally rotate the hip

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7
Q

Origin: Psoas Major

A

Deep - transverse processes of L1-4
Superficial - lateral surface of T12-L4

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8
Q

Which muscles attach to the iliotibial tract?

A

Gluteus maximus
Tensor fascia lata

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9
Q

Where does gluteus maximus insert?

A

Iliotibial tract and gluteal tuberosity of the femur

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10
Q

Nerve: Gluteus maximus

A

Inferior gluteal nerve (L5-S1)

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11
Q

Action: Gluteus maximus

A

Extension and external rotation of the hip

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12
Q

Nerve: Tensor fascia lata

A

Superior gluteal nerve

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13
Q

Insertion: Gluteus medius and minimus

A

Lateral surface of the greater trochanter

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14
Q

Action: Gluteus medius

A

Abduction during standing
Stabilises the pelvis during walking

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15
Q

Trendelenburg’s gait is associated with which nerve dysfunction?

A

Superior gluteal nerve (passes 5cm superior to the greater trochanter)

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16
Q

Pathway of the sciatic nerve in the pelvis

A

Exits via the greater sciatic foramen emerging below the piriformis muscle

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17
Q

What structures stabilise the knee?

A

AP - ACL + PCL (stronger)
Lateral - LCL + MCL

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18
Q

Which collateral knee ligament is more prone to injury?

A

Medial collateral ligament as it is closely related to the medial meniscus and joint capsule

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19
Q

What is the ‘terribe triad’ of knee injuries?

A

ACL + Medial Meniscus + MCL

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20
Q

Where does the ACL attach?

A

Arises on the lateral wall of the intercondylar notch

Inserts between the tibial spines

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21
Q

How do you avoid DVT in patients undergoing TKR?

A
  • TEDs/Flowtrons
  • LMWH
  • Early mobilisation
  • Hydration
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22
Q

What neurovascular structures are at risk in an anteromedial approach to the knee?

A

Saphenous Nerve
Great Saphenous Vein
Geniculate Arteries

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23
Q

Blood supply to the knee

A

Genicular anastamosis formed from the femoral, popliteal and crural arteries

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24
Q

Nerve supply: Quadriceps

A

L2,3,4 Femoral Nerve

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25
Q

How do you differentiate semimembranosus and semitendinosus?

A

Both originate from the ischial tuberosity

Semimembranosus is more medial and has a membrane-like insertion

Semitendinosus is distinguishable by its large tendon insertion

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26
Q

Contents of the popliteal fossa (superficial to deep)

A

Common fibular and tibial nerves
Popliteal vein
Short Saphenous vein
Popliteal artery

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27
Q

What are the boundaries of the popliteal fossa?

A

Superomedial – semimembranosus
Superolateral – biceps femoris
Inferomedial – medial head of gastrocnemius
Inferolateral – lateral head of gastrocnemius and plantaris

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28
Q

What area is drained by the popliteal lymph nodes?

A

Area drained by the short saphenous vein

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29
Q

Which muscles form ‘pes anserinus’?
(Anterior to Posterior)

A

Sartorius, gracilis and semi tendinosis

“Say Grace before Tea “

30
Q

What is the ankle joint?

A

Synovial joint of the lower limb, between the tibia, fibula and talus bones

31
Q

What joint is responsible for inversion and eversion of the foot?

A

Subtalar joint (between talus and calcaneum)

32
Q

Which ligamentous structures support the ankle joint?

A

Medially - deltoid ligament (between the medial malleolus of the tibia and the talus, calcaenum and navicular)

Laterally - anterior and posterior talofibular ligaments, calcaneofibular ligament

33
Q

What are the 4 parts of the tibio-fibular syndesmosis?

A

anterior and posterior inferior talofibular ligaments
interosseous ligament
inferior transverse ligament

34
Q

Sensation: lateral border of the foot

A

Sural nerve

35
Q

Sensation: medial border of the foot

A

Saphenous nervePo

36
Q

Sensation: posterior aspect of the foot/sole

A

Tibial nerve

37
Q

Sensation: dorsum of the foot (except the first web space)

A

Superficial peroneal nerve

38
Q

Sensation: first web-space of the dorsum of the foot

A

Deep peroneal nerve

39
Q

Pulse: posterior tibial

A

2-3cm distal & posterior to the tip of the medial malleolus

40
Q

Pulse: dorsalis pedis

A

just lateral to EHL tendon proximally

41
Q

What is dorsalis pedis artery a continuation of?

A

Anterior tibial artery

42
Q

What structures run posterior to the medial malleolus? (anterior to posterior)

A

Tibialis anterior tendon
Flexor digitorum longus tendon
Posterior tibial artery
Posterior tibial vein
Tibial nerve
Flexor hallucis longus tendon

Remember: Tom, Dick And Very Naughty Harry

43
Q

Muscles of the superficial posterior compartment of the leg

A

Gastrocnemius
Soleus
Plantaris

44
Q

Muscles of the deep posterior compartment of the leg

A

Flexor digitorum longus
Tibialis posterior
Flexor hallucis longus
Popliteus

45
Q

Origin and insertion of peroneal longus

A

Origin - head of the fibula

Inserts - base of the 1st metatarsal and medial cuneiform

46
Q

Origin and insertion of peroneal brevis

A

Origin - lower 2/3rd of the lateral fibula

Inserts - base of 5th metatarsal

47
Q

Origin and insertion of peroneal tertius

A

Origin - lower 1/3rd of anterior fibula and lower IOM

(passes under extensor retinaculum)

Inserts - base of 5th metatarsal

48
Q

How does peroneal tertius differ from the other peroneal muscles?

A

Located in the anterior compartment, innervated by the deep peroneal nerve and runs under the extensor retinaculum

49
Q

What vessels run deep to extensor hallucis longus in the leg?

A

Anterior tibial artery and vein

(deep peroneal nerve runs deep to it)

50
Q

How wound you test knee L3/4 reflex?

A

Describe test and adequately expose patient (entire thigh)
Strike patellar tendon, looking for quadricep contraction

51
Q

How wound you test ankle S1/2 reflex?

A

Describe test and adequately expose patient (entire leg), position foot pointing laterally and dorsiflexed
Strike achilles tendon, looking for posterior calf contraction

52
Q

Which muscles assist in dorsiflexion?

A

Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneal tertius

53
Q

What does the popliteal artery split into?

A

Anterior tibial artery
Tibioperoneal trunk (further splits into the posterior tibial and peroneal arteries)

54
Q

How do the arteries of the leg appear on angiogram?

A

Medial - posterior tibial artery
Middle - peroneal artery
Lateral - anterior tibial artery

55
Q

Which nerve is located in the superficial posterior compartment of the leg?

A

medial sural cutaneous nerve

56
Q

What does the anterior fascial septum of the leg divide?

A

Anterior and lateral compartments

57
Q

What does the posterior facial septum of the leg divide?

A

Lateral and posterior compartments

58
Q

What structures attach to the linea aspera?

A

Pectineus
Adductors (magnus, brevis, longus)
Vastas medialis & lateralis
Intermuscular septa (lateral and medial)
Short head biceps femoris

Remember: PAVIS

59
Q

How would you perform a leg fasciotomy?

A

Explain procedure and consent patient
Prep & drape
Decompress anterior & lateral compartments - anterolateral incision 2cm anterior to fibula (from level to tibial tuberosity to above ankle)
Decompress two posterior compartments with posteromedial incision - from tibial tuberosity to 5cm above medial malleolus
Debride necrotic tissues and leave open

60
Q

Which leg muscles attach to the medial cuneiform?

A

Tibialis anterior
Tibialis posterior
Peroneus longus

61
Q

What are the surface markings of the great saphenous vein?

A

Formed from the dorsal vein of the great toe joining the dorsal venous arch, it passes anterior to medial malleolus, runs up medial leg, runs posterior to medial epicondyle of the femur, ascends medial thigh, enters saphenous opening of the fascia lata to join the femoral vein within the femoral triangle

62
Q

Which nerves form the sural nerve?

A

Medial sural cutaneous branch of the tibial nerve and the sural communicating branch of the common peroneal nerve

63
Q

What gives rise to the saphenous nerve?

A

Femoral nerve

64
Q

What are the 3 arches of the foot?

A

Medial longitudinal
Lateral longitudinal
Transverse

65
Q

What forms the medial longitudinal arch of the foot?

A

Bones: calcaneum, talus, navicular, 3 cuneiforms, medial 3 metatarsals

Ligaments: interosseous, spring

Muscles: FHL, FDL, FDB, Tib ant/pos

66
Q

What forms the lateral longitudinal arch of the foot?

A

Bones: calcaneum, cuboid, lateral 2 metatarsals

Ligaments: long & short plantar

Muscles: PL, FDL, FPB (to 4th and 5th digits)

67
Q

What forms the transverse arch of the foot?

A

Bones: bases of metatarsal heads 1-5

Ligaments: interosseous

Muscles: peroneus longus

68
Q

What are the layers of the sole of the foot? (deep to superficial)

A
  1. plantar and dorsal interossei, tendons of peroneus longus and tibialis posterior
  2. FHB, adductor hallucis, flexor digiti minimi
  3. Quadratus plantae, lumbricals, tendons of FDL and FHL
  4. Abductor hallucis, abductor digiti minimi, flexor digitorum brevis
69
Q

What arteries form the plantar arch?

A

Lateral plantar branch of the posterior tibial artery anastomoses with deep plantar branch of the dorsalis pedis

70
Q

Testing motor L5 nerve root

A

EHL - big toe extension

MRCS Part B (7 decks)

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