L8.1 - Leg, bones and muscles

Question 1

What do the medial and lateral tibial plateau come together to form?

Answer 1

Tubercles of intercondylar eminence

Question 2

Patella - posterior medial and lateral facet makes contact with the _ of the tibia

Answer 2

Condyles

Question 3

Is the tibia or fibula more likely to be fractured?

Answer 3

Tibia

Question 4

Osgood–Schlatter disease

Answer 4

Aka apophysitis of the tibial tubercle, or Lannelongue’s disease, is an inflammation of the patellar ligament at the tibial tuberosity. It is characterized by a painful lump just below the knee and is most often seen in young adolescents - it is caused by the sliding off of unfused epiphyses.

Question 5

Where do most tibial fractures occur?

Answer 5

At junction of middle and inferior thirds - bone narrowest and poor blood supply.
*aka boot-top fracture in skiers

Question 6

Tibial fractures are often comminuted - what does this mean?

Answer 6

Bone completely breaking off, producing multiple bone splinters - leads to displacement of fibula and endangers common fibular nerve

Question 7

Pott’s fracture

Answer 7

A fracture of the lower end of the fibula, usually involving a dislocation of the ankle

Question 8

In the thigh fascia is aka fascia lata, in the leg, it is known as _. They are continuous with each other.

Answer 8

Crual fascia

Question 9

In the leg, intermuscular septa form 3 compartments - what are they?

Answer 9

1) Anterior - DF + invertors
2) Lateral - Evertors
3) Posterior - PF + invertors

Question 10

Crural fascia is continous with _ superiorly, _ anteriorly, _ inferiorly, _ deep to it

Answer 10

Superiorly - fascia lata
Anteriorly - Periosteum of tibia
Inferiorly - Ankle retinaculae
Deep to it - intermuscular septa

Question 11

Ankle retinaculae - what type and how many are there?

Answer 11

1 Flexor - medial malleolus to calcaneous
2 Extensor - (sup) connects tibial and fibular malleolus, (inf) y shaped fibres where one is on medial malleolus and one is on calcaneous and they both insert on the lateral calcaneus
2 Fibular (lateral) - (sup) goes from lat malleolous to calcaneus, (inf) the stem of Y that is continuing onto calcaneus

Question 12

Which compartment of the leg gets compartment syndrome usually? What structures are affected?

Answer 12

Anterior - lymphatics, veins, arteries, nerves (+ vessels to nerves - ischaemia of nerve)

Question 13

Treatment for compartment syndrome?

Answer 13

Fasciotomy to decompress it

Question 14

Symptoms of compartment syndrome?

Answer 14

Pain (on exertion), pale, pulse-less, paraesthesia (lack of sensation)

Question 15

Common fibular nerve passes behind ____

Answer 15

Neck and head of fibula

Question 16

If common fibular nerve is damaged, what actions are affected?

Answer 16

DF, eversion - leading to foot drop (dragging feet) or steppage gait/swinging gait/waddling gait

Question 17

What does the superficial fibular nerve supply?

Answer 17

Muscles then skin of distal leg and dorsum of foot

Question 18

What does deep fibular nerve supply?

Answer 18

Pierces anterior intermuscular septum to anterior compartment

Question 19

Common peroneal nerve is compressed at?

Answer 19

Lateral knee

Question 20

Where are the venous sinuses in the posterior leg muscles?

Answer 20

Soleus

Question 21

Achillies tendinitis

Answer 21

Achilles tendinitis is an overuse injury of the Achilles tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone. Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs.

Question 22

Virchow’s triad - think about an old man named virchow on a plane

Answer 22

1) Hemodynamic changes - Tendency for blood to pool downwards
2) Endothelial injury/disfunction - Aging causes laxity of vessels
3) Hypercoagulability - In times of great inactivity - blood coagulates and thrombosis could go up to heart and lodge in lungs