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Regional Anatomy > Applied Clinical Anatomy of Lower Limb > Flashcards

Applied Clinical Anatomy of Lower Limb Flashcards

1
Q

Describe the difference between the intertrochanter line and the intertrochanter groove

A
  • Intertrochanter line is a line between the 2 trochanter’s anteriorly, whereas the intertrochanter crest is a line between the 2 trochanters posteriorly.
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2
Q

Where does the joint capsule attach to the head of the femur and what does this make the intertrochanter line and crest

A
  • Anteriorly - intertrochanter line
  • Posteriorly - 1.25cm above intertrochanter crest.
  • This makes the intertrochanter line intracapsular and the intertrochanter crest extracapsular
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3
Q

What are the ligaments that reinforce the hip joint

A
  • Iliofemoral ligament (anteriorly)
  • Pubofemoral ligament (anteriorly)
  • Ischiofemoral ligament (posteriorly)
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4
Q

What is special about the iliofemoral ligament

A
  • Has 2 bands (superior and inferior)
  • Strongest ligament in the body
  • Also known as ligament of Bigelow
  • Posterior hip fractures occur more often as the posterior side is less reinforced
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5
Q

Describe the anterior blood supply to the femoral head

A
  • Lateral circumflex femoral artery (branch of profunda femoris artery)
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6
Q

Describe the posterior blood supply to the femoral head

A
  • Medial circumflex artery (branch of profunda femoris artery)
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7
Q

Describe how the medial and lateral circumflex arteries ensure the vascularisation of the whole head of the femur

A
  • They form a ring around the femoral neck and give off retinacular vessels.
  • The retinacular vessels travel in a retrograde fashion to supply the femoral head.
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8
Q

Describe what is meant my vessels travelling in retrograde fashion

A
  • They move in an upwards direction in the case of the neck of the femur to the head of the femur.
  • Move from distal to proximal
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9
Q

What is the blood supply of the fovea of the femur (top of the head)

A
  • Supplied artery of ligamentum teres (branch from the obturator artery)
  • Accompanies the ligamentum teres femoris.
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10
Q

What other vessels contribute to the blood supply of the head of the femur

A
  • Gluteal arteries (inferiroly)
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11
Q

What makes the femoral head more prone to avascular necrosis

A
  • A fracture of the neck of the femur
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12
Q

Name the 3 intracapsular fractures of the femur

A
  • Subcapital
  • Cervical
  • Basal
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13
Q

Name the 2 extracapsular fractures of the femur

A
  • Intertrochanteric fracture
  • Subtrochanteric fracture
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14
Q

Out of extracapuslar and intracapsular fractures which are most likely to cause AVN

A
  • Intracapsular fractures - they cause the tearing of retinacular vessels.
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15
Q

What bones make up Shenton’s Line

A
  • Superior ramus of pubis (inferior border)
  • Femoral neck (medial border)
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16
Q

What image on an X-ray will show a fracture of the neck of the femur

A
  • Distortion of the Shenton’s Line (No n shape)
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17
Q

What other fracture can the distortion of the Shenton’s Line signify

A
  • Fracture of the superior ramus of the pubis
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18
Q

Why must further investigations be carried out despite a normal Shenton’s Line

A
  • Shenton’s line is not always distorted by a fracture of the femoral neck.
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19
Q

What are some other things to look out for when assessing for a femoral neck fracture

A
  • Shortening of the limb
  • External rotation (shown by a more prominent lesser trochanter is X-ray)
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20
Q

What are the 4 classifications of intracapsular fractures of the femoral neck using garden classification

A
  • I - Incomplete fracture of through femoral neck, no displacement.
  • II - Complete fracture through femoral neck, no displacement.
  • III - Complete fracture through femoral head, slight angulation/ displacement of femoral head.
  • IV - Complete fracture through femoral neck with complete displacement of femoral head.
21
Q

What 2 categories can you split garden classified intracapsular fractures into and which apply to what category

A
  • Un-displaced (fracture types 1&2)
  • Displaced (fracture types (3%4)
22
Q

What would the management plan for a hip fracture look like

A
  • Resuscitation (attending to symptoms such as pain using morphine)
  • Analgesia
  • Investigate the cause of fracture
  • Treatment by surgery
23
Q

What factors must be considered when treating a hip fracture by surgery

A
  • If femoral head can be preserved or not.
  • This is dependant on how much of the blood supply is compromised by displacement of the femoral head.
24
Q

What factors must be considered when treating a hip fracture by surgery

A
  • If femoral head can be preserved or not.
  • This is dependant on how much of the blood supply is compromised by displacement of the femoral head.
25
Q

What would the surgical treatment for a Un-displaced fracture of the femoral neck be

A
  • In-situ pinning using 3 screws
25
Q

What would the surgical treatment for a Un-displaced fracture of the femoral neck be

A
  • In-situ pinning using 3 screws
26
Q

What would the surgical treatment for a displaced fracture of the femoral neck be, explain why this treatment has its name

A
  • Partial hip replacement
  • Only replacing one articular surface in the joint
27
Q

What is the position of the limb following a posterior dislocation of the hip

A
  • Internally rotated
28
Q

What vessels are damaged during posterior dislocation of the hip

A
  • Compression of sciatic nerve (running posteriorly)
  • Stretching and tearing of femoral artery, vein and nerve (running anteriorly)
29
Q

What are the causes of posterior dislocation of the hip joint

A
  • High impact accident (car crash often)
  • Developmental problems (acetabular fossa is not correctly formed)
  • Total hip replacement surgery
30
Q

COMPARTMENT OF THIGH

A

COMPARTMENT SYNDROME

30
Q

COMPARTMENT OF THIGH

A

COMPARTMENT SYNDROME

31
Q

Where and how can you feel the femoral pulse

A
  • Compressing the artery below the mid-inguinal point against superior ramus of pubis.
32
Q

Where can the mid-inguinal point be found

A
  • Halfway between ASIS and pubic symphysis.
33
Q

Where and how can you feel the popliteal pulse

A
  • Back of the knee
  • Flexing the knee and pressing deep
  • May be difficult to feel so do not diagnose absence of peripheral pulses.
34
Q

Where and how can you feel the dorsalis pedis pulse

A
  • Dorsal surface of the foot
  • Pulsate lateral to ligament of extensor hallucis longus
  • Feel in more proximal area as distal branches run deeper
35
Q

Where and how can you feel the posterior tibial pulse

A
  • In the tarsal tunnel
  • 1/3 of the distance along a line passing between the posterior border of the medial malleolus and the calcaneal tendon
36
Q

What are the contents of the tarsal tunnel and what is a way to remember them

A
  • Tibialis posterior
  • flexor Digitorum longus
  • posterior tibial Artery
  • tibial Nerve
  • flexus Hallucis longus
  • Talented Doctors Are Never Hungry
37
Q

What is a Deep Vein Thrombosis

A
  • A blood clot in a vein of the deep venous system
38
Q

What are the risk factors for DVT known as

A
  • Virchow’s triad
  • Abnormal pregnancy (blood flow to heart is slower due to no action from muscle pump)
  • Hypercoagulable (pregnancy, previous DVT, malignant disease)
  • Endothelial injuries
39
Q

Name the 2 superficial veins in the lower limb

A
  • Great saphenous vein
  • Small saphenous vein
40
Q

Name the deep veins in the lower limb

A
  • Anterior tibial veins
  • Posterior tibial veins
  • Fibula veins
  • Popliteal vein
  • Femoral vein
  • External Iliac vein
41
Q

How do the 2 superficial veins ultimately drain into deep veins

A
  • Great saphenous vein - passes through saphenous opening in deep fascia and drains into femoral vein
42
Q

How do the 2 superficial veins ultimately drain into deep veins

A
  • Great saphenous vein - passes through the saphenous opening in deep fascia and drains into the femoral vein
  • Small saphenous vein - pierces through the popliteal fossa’s deep fascia and drains into popliteal vein.
43
Q

Where is the saphenous opening located

A
  • 3 cm lateral to pubic tubercle
44
Q

What is the role of perforator veins

A
  • Connecting superficial and deep veins
45
Q

What is the difference between thrombosis and embolism and how can embolism be distinguished

A
  • Thrombosis - reduced blood flow due to blood clot.
  • Embolism - blockage due to blood clot
  • Embolism causes swollen, shiny, painful, tender leg
46
Q

What is common complication of DVT

A
  • Pulmonary embolism

Regional Anatomy (13 decks)

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