Clinical: Thigh and Gluteal Region

Question 1

Femoral triangle access

Answer 1

• Femoral arterial access
• Femoral venous access
• Femoral nerve block
• Ultrasound guidance is commonly used for the above

Question 2

Femoral arterial access

Answer 2

• Inferior to midinguinal point (palpate for pulsations)

- Midinguinal point is halfway between ASIS and pubic symphysis

Question 3

Femoral venous access

Answer 3

• Palpate femoral artery pulsation at midinguinal point below inguinal ligament
• Access vein medial to pulsations

Question 4

Femoral nerve block

Answer 4

• Immediately lateral to femoral artery pulsations

Question 5

Compartment Syndrome

Answer 5

• Increased intracompartmental pressure exceeds perfusion pressure
• Venous outflow is compromised
• Really high pressure can impair arterial flow

Question 6

Compartment Syndrome can cause

Answer 6

• Muscle and nerve ischemia

Question 7

Untreated Compartment Syndrome can result in

Answer 7

• Ischemic necrosis of muscles/nerves

Question 8

Compartment Syndrome can be caused by

Answer 8

• Events that increase fluid content or decrease compartment size
• Trauma that results in hemorrhage and edema
• Fractures, gunshot wounds,
• Intense muscle use, post-surgical

Question 9

Common locations of Compartment Syndrome

Answer 9

• Thigh and gluteal compartments not as common as leg/foot

- Treated with fasciotomy

Question 10

Occlusion of femoral artery proximal to origin of profunda femoris can be relieved by anastomotic channels

Answer 10

• 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

Question 11

Femoral nerve neuropathy can result from

Answer 11

• Entrapment under the inguinal ligament, around iliopsoas muscle, adductor canal
• Injured during surgery
• Trauma, mass (hematoma), infection, diabetes

Question 12

Symptoms of femoral nerve neuropathy

Answer 12

• 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

Question 13

Bicondylar angle (carrying angle)

Answer 13

• 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)

Question 14

Bicondylar angle (carrying angle) develops

Answer 14

• During childhood

- In place by age7-8

Question 15

Characteristic of bicondylar angle

Answer 15

• Unique to humans (bipedalism)

Question 16

Bicondylar angle during gate

Answer 16

• Places the knee/foot under center of gravity during single support phase of gait

Question 17

Angle of inclination

Answer 17

• Angle formed by long axis of femur head/neck with long axis of the shaft
• Varies with age
• Birth ~ 150⁰, decreases with age

Question 18

Angle of inclination normal range in adults

Answer 18

• 125-135⁰

Question 19

Coxa valga

Answer 19

• Angle of inclination > 135⁰ (some say 140⁰)

- Can cause genu varum (bow-legged)

Question 20

Coxa vara

Answer 20

• Angle of inclination < 120⁰

- Can cause genu valgum (knocked knee)

Question 21

Coxa vara and valga can increase risk of

Answer 21

• Knee osteoarthritis

Question 22

Angle of Femoral Torsion (Angle of Declination)

Answer 22

• 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

Question 23

Angle of femoral torsion normal range

Answer 23

• Between 8-15(20)⁰

Question 24

Increased angle of femoral torsion

Answer 24

• Anteversion: > 15⁰

Question 25

Decreased angle of femoral torsion

Answer 25

• Retroversion: <8⁰

Question 26

Anteversion

Answer 26

• Toe-in gait
• Increased medial hip rotation
• Decreased lateral hip rotation

Question 27

Retroversion

Answer 27

• Toe-out gait
• Decreased medial hip rotation
• Increased lateral hip rotation

Question 28

Normal acetabular angle of torsion

Answer 28

• 15-20ᵒ

- Between anterior and posterior acetabular margins and sagittal plane

Question 29

Avulsion fractures

Answer 29

• 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)

Question 30

Apophyses (2⁰ ossification centers) in children

Answer 30

• Generally weaker than the tendons that attach to them

- Site of growth plate (physis)

Question 31

Growth plate (physis) at the apophysis

Answer 31

• Cartilage
• Weakest part of the immature skeleton
• Has not fused completely with the rest of the developing bone

Question 32

Avulsion fractures caused by

Answer 32

• Strong muscle contraction and/or sudden passive lengthening the muscle
• Can also occur at site of ligament and capsule