Clinical: Thigh and Gluteal Region Flashcards
Femoral triangle access
- Femoral arterial access
- Femoral venous access
- Femoral nerve block
- Ultrasound guidance is commonly used for the above
Femoral arterial access
- Inferior to midinguinal point (palpate for pulsations)
- Midinguinal point is halfway between ASIS and pubic symphysis
Femoral venous access
- Palpate femoral artery pulsation at midinguinal point below inguinal ligament
- Access vein medial to pulsations
Femoral nerve block
- Immediately lateral to femoral artery pulsations
Compartment Syndrome
- Increased intracompartmental pressure exceeds perfusion pressure
- Venous outflow is compromised
- Really high pressure can impair arterial flow
Compartment Syndrome can cause
- Muscle and nerve ischemia
Untreated Compartment Syndrome can result in
- Ischemic necrosis of muscles/nerves
Compartment Syndrome can be caused by
- Events that increase fluid content or decrease compartment size
- Trauma that results in hemorrhage and edema
- Fractures, gunshot wounds,
- Intense muscle use, post-surgical
Common locations of Compartment Syndrome
- Thigh and gluteal compartments not as common as leg/foot
- Treated with fasciotomy
Occlusion of femoral artery proximal to origin of profunda femoris can be relieved by anastomotic channels
- Trochanteric and cruciate anastomoses
- Obturator artery (internal iliac) and medial circumflex femoral artery (profunda femoris)
- Deep circumflex iliac artery (external iliac artery)/superficial circumflex iliac (femoral) and lateral circumflex femoral (profunda femoris)
- Internal iliac connections with branches of the profunda femoris
Femoral nerve neuropathy can result from
- Entrapment under the inguinal ligament, around iliopsoas muscle, adductor canal
- Injured during surgery
- Trauma, mass (hematoma), infection, diabetes
Symptoms of femoral nerve neuropathy
- Depend on location of lesion
- Loss/weakness of knee extension
- Weak hip flexion
- Loss/depressed patellar reflex
- Decreased sensation:
- Anteromedial thigh/knee
- Medial leg and knee
Bicondylar angle (carrying angle)
- Angle between the femur diaphysis and line perpendicular to the infracondylar plane
- Distal femur is angled medially
- Measures between 8-14⁰ in coronal plane (F>M)
Bicondylar angle (carrying angle) develops
- During childhood
- In place by age7-8
Characteristic of bicondylar angle
- Unique to humans (bipedalism)
Bicondylar angle during gate
- Places the knee/foot under center of gravity during single support phase of gait
Angle of inclination
- Angle formed by long axis of femur head/neck with long axis of the shaft
- Varies with age
- Birth ~ 150⁰, decreases with age
Angle of inclination normal range in adults
- 125-135⁰
Coxa valga
- Angle of inclination > 135⁰ (some say 140⁰)
- Can cause genu varum (bow-legged)
Coxa vara
- Angle of inclination < 120⁰
- Can cause genu valgum (knocked knee)
Coxa vara and valga can increase risk of
- Knee osteoarthritis
Angle of Femoral Torsion (Angle of Declination)
- Angle between long axis of femur head/neck and coronal plane of condyles (bicondylar plane, transcondylar axis)
- View from transverse plane
- ~ 40⁰ at birth, decreases with age
Angle of femoral torsion normal range
- Between 8-15(20)⁰
Increased angle of femoral torsion
- Anteversion: > 15⁰
Decreased angle of femoral torsion
- Retroversion: <8⁰
Anteversion
- Toe-in gait
- Increased medial hip rotation
- Decreased lateral hip rotation
Retroversion
- Toe-out gait
- Decreased medial hip rotation
- Increased lateral hip rotation
Normal acetabular angle of torsion
- 15-20ᵒ
- Between anterior and posterior acetabular margins and sagittal plane
Avulsion fractures
- Bone fracture that occurs when a fragment of bone is separated from the rest of the bone
- More common in children and adolescents (but do occur in the adult)
Apophyses (2⁰ ossification centers) in children
- Generally weaker than the tendons that attach to them
- Site of growth plate (physis)
Growth plate (physis) at the apophysis
- Cartilage
- Weakest part of the immature skeleton
- Has not fused completely with the rest of the developing bone
Avulsion fractures caused by
- Strong muscle contraction and/or sudden passive lengthening the muscle
- Can also occur at site of ligament and capsule
