Applied Clinical Anatomy of Lower Limb Flashcards
Hip joint type
Ball and socket synovial
Articulating bones in hip
- Innominate hip bone
> Ileum
> Ischium
> Pubis - Femur
Which ligament completes the acetabulum?
Transverse acetabular ligament
Intertrochanteric line vs crest
- Line = anterior, slightly raised
- Crest = posterior, more prominent
Where does the hip joint capsule attach to the femur?
- Intertrochanteric line (anterior)
- 1.5cm above intertrochanteric crest (posterior)
Ligaments supporting the hip joint
- Iliofemoral
- Ischiofemoral
- Pubofemoral
Why are posterior hip dislocations more common?
- Iliofemoral ligament strongest
- Much less support from this on posterior aspect
Which people are hip fractures most common in?
Elderly females
Vascular supply to head of femur
- Originally from medial/lateral circumflex arteries
- Retinacular vessels branch from these and supply distal to proximal
- Artery of ligamentum teres branches off obturator artery to supply fovea capitis
What forms Shenton’s line?
- Medial border of femoral neck
- Inferior border of superior pubic ramus
What does loss of Shenton’s line suggest?
- Femoral neck fracture
- Superior pubic ramus fracture
Position of lower limb after hip fracture
- Shortened
- Externally rotated
Garden classification of femoral neck fractures
- I = incomplete/impacted bone injury with valgus angulation of distal component
- II = complete + undisplaced
- III = complete + partially displaced
- IV = complete + totally displaced
Basic management principles of femoral neck fracture
- Resuscitation
- Analgesia
- Investigate cause
- Surgery (urgent reduction + internal fixation)
What internal fixation is used to treat a non-displaced hip fracture?
In-situ pinning with screws
What internal fixation is used to treat a displaced hip fracture?
Partial hip replacement (hemiarthroplasty)
Causes of posterior hip dislocation
- Trauma
- Developmental (eg. acetabular fossa not well developed)
- Hip replacement surgery
What neurovasculature is contained in each compartment of the thigh?
- Anterior = femoral artery, vein + nerve, great saphenous vein
- Medial = profunda femoris artery + vein, sciatic nerve
- Posterior = sciatic nerve, perforating branches of femoral vessels
What neurovasculature is contained in each compartment of the leg?
- Anterior = deep fibular nerve, anterior tibial vessels
- Lateral = superficial fibular nerve
- Posterior = tibial nerve, posterior tibial vessels
Causes of compartment syndrome
- Extremity fractures (open/closed)
- Direct blow to extremity
- Crush mechanism
- Patients on coagulation
- Reperfusion injuries
- Tight bandages/dressings
- Burns
Warning signs/symptoms of compartment syndrome
- Significant swelling
- Pain out of proportion of injury
- Increasing pain medication needs
- Pain with movement of fingers/toes
- Numbness/tingling nerves within compartment
- Motor weakness
- Cooler temperature of extremity
How are all 4 of the leg compartments decompressed in compartment syndrome?
- Bilateral fasciotomy:
> Anterolateral incision for anterior + lateral compartments
> Posteromedial incision for deep + superficial posterior compartments
Contents of the femoral triangle (lateral to medial)
- Femoral nerve
- Femoral artery
- Femoral vein
- Lymphatics
Where is the femoral pulse felt?
Mid-inguinal point
Contents of the popliteal fossa (lateral to medial)
- Common fibular nerve
- Tibial nerve
- Popliteal vein
- Popliteal artery
How is the popliteal pulse felt?
- Flex knee
- Press deep
How is the dorsalis pedis pulse felt?
- Look for EHL tendon
- Dorsalis pedis artery just lateral to it
- Palpate proximally as artery has a deeper course distally
Contents of the tarsal tunnel (anterior to posterior)
- Tibialis posterior tendon
- FDL tendon
- Posterior tibial artery
- Tibial nerve
- FHL tendon
Where is the posterior tibial pulse felt?
1/3 along the line from posterior border of medial malleolus to calcaneal tendon
What does the great saphenous vein empty through, where is this, and what does it empty into?
- Saphenous opening
- 3cm lateral to distal pubic tubercle
- Femoral vein
What does the small saphenous vein empty into, where, and how?
- Popliteal vein
- Popliteal fossa
- Pierces through deep fascia
What assist the openings in the saphenous veins in draining blood from superficial to deep veins?
Perforators
Perforators of the leg, and where they are located
- Hunterian perforator (proximal thigh)
- Dodd perforator (distal thigh)
- Boyd’s perforator (around knee)
- Cockett’s perforator (posterior arch vein)
How do varicose veins arise?
- Incompetent valve in perforator
- Blood flows from higher pressure in deep vein to lower in superficial
- Swelling of superficial makes visible
Types of cause of DVT
- Blood flow
- Hypercoagulability
- Endothelial injury
Causes of DVT
THROMBOSIS:
- Trauma
- Hormones - OCPs
- Road traffic accident
- Operations - cholecystectomy
- Malignancy
- Blood disorders - polycythemia
- Obesity, old age, orthopaedic surgery
- Serious illness
- Immobilisation
- Splenectomy
Presentation of DVT
- Swollen, tender calf
- Fever
Complications of DVT
Pulmonary embolism
Management of DVT
- Risk assessment
- Anticoagulation
