Final review : Leg, knee, femur , foot, ankle Flashcards
Two bones of the leg
tibia and fibula
largest second bone in the body
tibia
what side is the tibia located on
medial
what side is the fibula located on
lateral side and slightly posterior
two prominent and palpable processes on the proximal end of the tibia
medial and lateral condyles
sharp projection between articular facets
intercondylar eminence
what forms articular facets (plateus) for femur as part as the knee joint
superior surfaces of condyles
has facet on posterior surface for articulation with the fibula
lateral condyle
-anterior surface of tibia, inferior to condyles
-serves as point of attachment for muscles
tibial tuberosity
-located at distal end of tibia
-palpable landmark
-forms part of ankle mortise
medial malleolus
-triangular depression for articulation with distal fibula
-distal tibiofibular joint is amphiarthotic (slightly moveable)
fibular notch
both classified as long bone
tibia and fibula
does not bear weight
fibula
proximal end of fibula and articulates with lateral condyle of tibia
head of fibula
conical projection on lateral, posterior head
apex of fibula
-distal end of fibula
-forms part of ankle mortise
-projects lower than medial malleolus
lateral malleolus
-formed by femoral condyles and tibial plateaus
- synovial diarthrodial, hinge type joint
-protected by patella
-supported by ligaments
stabilized and cushioned by menisci
knee
lie on tibial plateuas
lateral and medial maniscus
largest, most constant sesamoid bone in the body
patella
-situated on the distal, anterior femur
-develops in quadriceps femoris tendon between 3 and 5 years of age
-triangular shaped
-apex points toward knee
-base is superior aspect
patella
largest bone in the body
femur
-proximal, rounded end
-articulates with acetabulum of pelvis to form hip joint
head of femur
slender region just below head
neck of femur
large prominent, palpable process at proximal end of lateral side
greater trochanter
located medial and posterior surface of femur
lesser trochanter
distal end, just above condyles
-designated as medial and lateral
epicondyles of femur
-expanded, palpable distal ends
-medial and lateral articulate with tibia to form knee joint
condyles of femur
depression between condyles on posterior surface of femur
intercondylar fossa
CR for AP and lateral lower leg
- perp to center of leg
distance for AP and lateral lower leg
SID maybe rasied to 48 inches to decrease magnification to fit image on IR
where is the lateral malleolus
on the fibula
where is the medial malleolus
on the tibia
If the leg does not fit for tib fib what can you do
-turn cassette catty corner
- increase sid to 48
what two joints do you need for the tib fib
ankle and knee joints
do you need to dorsiflex for ap and lateral tib fib
yes
how are the femoral condyles in the lateral tib fib
superimposed and perpendicular to IR
what is perpendicular to the IR in lateral leg
-patella
-femoral condyles
what views of the knee must be standing
weight bearing knees
distance for weight bearing knees
40 inches
how much do you angle for AP knee
5-7 degrees
where do you center for AP knee
1/2 inch below the patellar apex
how are the femoral epicondyles in the AP knee
parallel with IR
for a lateral knee, how much should you bend the knee?
20 to 30 degrees
how much do you angle the tube for a lateral knee?
5 to 7 degrees cephalic angle to move the medial condyles superior to superimpose it
which condyle has the adductor tubercle
medial condyle
what is the main purpose to put an angle on the lateral knee
because the medial condyles sit lower and we want to superimpose them
what is perpendicular in the lateral knee
epicondyles and patella are perpendicular to IR
what is superimposed in the lateral knee
condyles
where are we centering for a lateral knee
enters knee joint 1 inch distal to medial epicondyle
what is in profile in a lateral knee
patella
is the medial condyle anterior or posterior
anterior
is the lateral condyle anterior or posterior
posterior
how much do you rotated knee for medial oblique?
45 degrees medially
where do you center for medial oblique knee
1/2 inch below patellar apex
how do you know its a medial oblique knee
separate head of fibula and tibia, lateral condyle more magnified and the separation
rotation of knee for lateral oblique knee
45 degrees
what is being best demonstrated for lateral oblique knee
medial condyle
CR for ap oblique lateral knee
enters 1/2 inch below patellar apex
how is the fibula in the lateral oblique knee
fibula is rolling behind the tibia, laying on anterior surface of it
central ray for ap knee weight bearing
-horizontal and pependicular to center of IR
-enters 1/2 inch below patellar apex
for the knee, where do we measure at to determine the degree of angulation
the ASIS
In the AP knee, is the fibula superimposed over the tibia?
slightly- 1/4 of an inch
in the lateral oblique knee how is the fibula
fibula is superimposed on the anterior portion of the tibia
How do we know its a medial oblique knee?
Separates the fibula and tibia (joint space open between space of fibula head and tibia)
What are the views for the intercondylar fossa
holmblad (PA)
Camp coventry (PA)
Beclere (AP)
How much do you flex the knee for the Holmblad method
70 degrees
what is the CR for all three views for the intercondylar fossa
Perp to the tib fib
what is the patient position for camp coventry
prone
how is the knee flexed in the camp coventry and how much is the tube angled
knee flexed 40-50 degrees and tube angled 40-50 degrees
How is the knee flexed in the beclere
60 degrees
Settegast view is also called
sunrise view
tube angle for settegast (sunrise views)
Varies depending on the patients abilities to bending
what is in profile in the settegast view
patella
What kind of view is settegast
tangential
What is the CR for PA patella
perp to midpopliteal area
How much do you rotate the heel for the PA patella
5-10 degrees
Why is it preferred to do patella PA
because it is closer to the IR, better detail
Most common fracture of the patella
Transverse fractures
how much is the knee flexed in a lateral patella
5 to 10 degrees
how is the patella in a lateral patella
perp and in profile
CR for lateral patella
perp to ir, center over joint space between patella and femur
Rule out transveres fracture of patella before attempting this projection
Tangential patella (settegast)
CR for settegast
angle varies, perp to ir, perp to joint space
how is the patient positioned for hughston method
prone
How much do we rotate foot for the ap femur
10 to 15 degrees inward
what does rotating the foot do in the AP femur
Greater trochanter in profile and puts the femoral neck parallel to IR
What is being best demonstrated in the AP femur
greater trochanter
In the lateral femur what is being best demonstrated
The lesser trochanter
CR for the AP femur
perp to the IR
in the AP femur where should the top of the IR be?
at the ASIS
CR for the lateral femur?
perp to midpoint of IR
how is the patella in the lateral femur
in profile
how much do you rotate the pelvis for a lateral femur
10-15 degrees
eversion and inversion of the ankle or foot
stress view
distance for all of the lower limbs
40 inches
How many bones are in the foot
26
how many phalanges, metatarsals, and tarsal bones are there
14 phalanges
5 metatarsals
7 tarsals
what are the 7 tarsal bones
-calcaneus
-talus
-navicular
-cuboid
-three cuniforms
largest tarsal bone
calcaneus
second largest tarsal bone
talus
what joint does the talus articulate with the calcaneus at
“subtalar” joint
on the lateral side between calcaneus and the fourth and fifth metatarsals
Cuboid
On medial side between calcaneus and the cuneiforms
Navicular
what cuneiform is the smallest and largest
medial-largest
intermediate-smallest
The ankle joint is formed by articulation between the talus and the:
-lateral malleolus of fibula
-inferior surface of tibia
-medial malleolus of tibia
-small detached bones found in the foot
-usually form in points of stress near a joint
-usually found on the posterior surface of first MTP joint
-is possible to fracture and is very painful when fractured
Sesamoid
why is AP axial toes recommended rather with no angle
To open the joint spaces and reduce foreshortening
what is the holly and lewis views for?
tangential views for the sesamoid bones
Where do you center for the AP foot
perp to base of the 3rd metatarsal
What is the CR for the AP axial foot
5-7 degrees toward heel to the base of the third metatarsal
what does the AP axial foot demonstrate better than the AP foot
the axial projection demonstrates the tarsometatarsal joint spaces better and reduces foreshortening
term for top of the foot
dorsum
term for bottom of the foot
plantar
how much do you rotate the foot for the AP oblique medial rotation foot
30 degrees so the cuboid is parallel with the IR and best seen
what is important to include for ap medial oblique foot
cuboid, base of fifth, and heel
CR for AP medial oblique foot
perp to base of the 3rd metatarsal
what is the view that best demonstrates the cuboid
AP oblique medial rotation
CR for lateral foot
perp to base of metatarsals
do you dorsiflex for lateral foot
yes
when do you dorsiflex
when the ankle is involved
why is weightbearing feet done
to show the structure of the longitudinal arch
what is the CR for the axial (plantodorsal) Calcaneus
40 degrees cephalic
enters plantar surface at base of the third metatarsal
how much do you angle the tube for the plantodorsal calcaneus
40 degrees
How do we know what the medial aspect of the heel is?
the curvature, its concaved on the medial aspect
what is the other view besides plantardorsal for the heel
lateral
what joints do we need to see in the heel
subtalar joints
what do you need to be sure to include in the heel
dorsiflex, make sure to have ankle joints and base of the fifth
what fracture occurs at the base of the fifth
Jones Fracture (avulsion fracture)
CR for lateral calcaneus
perp to calcaneus
What bones make up the ankle joint
fibula, talus, tibia
CR for AP ankle
perp through ankle to midway between the malleoli
CR for lateral ankle
perp to ankle joint
enter medial mallelous
what do you need to include on lateral ankle
Be sure to dorsiflex and include heel and the fifth metatarsal base
How much do you rotate the foot for medial oblique ankle
45 degrees
CR for oblique ankle
perp to ankle joint, midway between the malleoli
why do we obliqe 45 degrees for oblique ankle
open joint spaces on lateral aspect to take fibula off of talus
how much do we rotate foot for ap oblique mortise
15 to 20 to open up joint spaces all around the ankle mortise
why is stress views done
to verify ligamentous tears
CR for PA ribs
perp to IR
Breathing technique for PA upper ribs
Full respiration
CR for AP ribs
Perp to center to IR
Breathing technique for AP ribs
upper- inspiration
lower-expiration
Rotation for AP oblique ribs
45 degree RPO or LPO
Where should the IR be for upper ribs oblique
place top of IR 1 1/2 inches above shoulder
Where should the IR be for lower ribs oblique
Place lower edge of IR at level of iliac crests
CR for AP oblique ribs
perp to center of IR
Rotation for PA oblique ribs
45 degree RAo or LAO
CR for PA oblique Ribs
perp to center of IR
