Clinical Anatomy of the Lower Limb Flashcards
78 year old female
Tripped over her cat
Unable to weight bear, complaining her right leg is extremely sore
PMHx (past medical history): Hypertension, T2DM (Type 2 diabetes mellitus)
DHx (drug history): Not relevant
Leg is externally rotated and shortened
Neck of femur fracture
Iliopsoas - main flexor of the hip
If neck of femur fracture, then iliopsoas has unopposed action.
This causes the leg to become shortened and externally rotated.
What happens if blood supply is cut off in an intra-capsular neck of femur fracture ?
Avascular necrosis of femoral head
How to diagnose neck of femur fracture ?
X-ray
Looking at the hip joint
Types of neck of femur fractures
Intracapsular
Extracapsular
Treatment for extra-capsular hip fracture
Dynamic hip screw
40 year old male
Attending child’s sports day
Took part in parent race
Started to sprint and heard a pop, felt like he’d been shot in the back of the leg
Struggled to walk after this
On examination weak plantar flexion, positive Thompson’s test
Calcaneal tendon rupture
Features of calcaneal tendon rupture
Most common tendon rupture in the lower limb
Men more affected than women
30-40 peak incidence
Risk fractures for calcaneal tendon rupture
Steroid injections
Fluoroquinolone antibiotics
Thompson’s test
Squeeze the leg, causes plantar flexion
What contributes to the calcaneal tendon ?
Medial and Lateral heads of gastrocnemius
Soleus
Plantaris
Treatment of Achilles tendon rupture
Surgery V Non-Surgical management
Surgical management of calcaneal tendon rupture
Try to remove the damaged part of the tendon.
Blood supply to the middle part of the calcaneal tendon is poor in comparison to the top and bottom aspects.
So you could potentially remove the damaged area and replace it with a tendon graft from elsewhere in the body.
Non-surgical management of Calcaneal tendon rupture
Aquinas boot
- foot is placed in the boot, plantar flexed
25 year old male presents after Road Traffic Accident
Unable to weight bear, swelling, bruising over right ankle
No other injuries
Currently - DVNI (distally neurovascularly intact)
Medial malleolus shifted, bruising
Fractured Fibula
Fractured Medial and Lateral Malleolus
Talar shift
Possible posterior tibial fracture (aka posterior malleolus)
TRI-MALLEOLAR FRACTURE
RISK of not treating tri-malleolar fracture
Inability to use foot
Sore foot
Poor healing
What is the dorsalis pedis artery a continuation of ?
Anterior tibial artery
Patient has post-operative pain (severe) despite huge amounts of morphine
Patient reports leg feeling tight
ON examination, loss of sensation and pain of passive stretch of the foot
Compartment Syndrome
- swelling of muscles causing compression of nerves and vessels
Symptoms of compartment syndrome
Pain upon passive stretch
Failure to control pain
Loss of sensation
18 year old male
Clipped by a car on the outside of his right leg
No PMHx, DHx, no other injuries noted
Presented to ED as he had problems walking
On examination you note he has a high stepping GAIT on the right side & weakness in dorsiflexion.
Foot drop
Common peroneal nerve injury
Causes of a High stepping GAIT and weakness in dorsiflexion
Common peroneal nerve injury
- this nerve goes lateral and wraps around the fibula
- this supplies the lateral and anterior compartments
- damage causes weakness in dorsiflexion and eversion
Where does the sciatic nerve split and what does it split into ?
Splits at the popliteal fossa
Splits into:
- Common peroneal nerve
- Tibial nerve
Symptoms of foot drop
Injury to common peroneal nerve
Tingling
Weakness
Numbness
Treatment of foot drop - common peroneal nerve damage
Physiotherapy
Orthotics
Treatment depends on the cause
