lower extremity Flashcards
what are the 26 bones of the foot? (distribution)
14 phalanges
5 metatarsals
7 tarsal bones
what are the divisions of the foot?
forefoot, midfoot, and hindfoot
what bones are a part of the forefoot?
toes and metatarsals
what bones are a part of the midfoot?
cuneiforms, navicular, and cuboid
what bones are a part of the hindfoot?
calcaneous and talus
what are the 3 cuneiforms
medial, middle, lateral
what is another word for calcaneous
os calcis
which side of the foot goes up in a 45 degree
the lateral (5th) side
what is the hallux
the great toe
what is different about the hallux
it has 2 sesamoids posterior to the head of the metatarsal, separated by a ridge of bone
why is the tuberosity of the 5th metatarsal significant
very common place to fracture
what is on the base of the fifth metatarsal
the tuberosity of the 5th metatarsal
what is a Jones’ fracture
twist injury
tendon pulls a small portion of the fifth metatarsal off
regularly causing avascular mecrosis
what is the most superior tarsal bone
the talus
what does the talus articulate with? (4)
tibia, fibula, calcaneous, navicular
what makes the talus a ball and socket joint
the head that articulates with navicular
what part of the talus articulates with the tibia and fibula
talar domes
what is the sulcus tali and where is it
the groove that forms the roof of the sinus tarsi
(inferior neck of the talis)
what is the sinus tarsi
the hole inferior to the talus
what does the talus have 3 of
articular facets (articulate with the ant/mid/pos calcaneous)
what are the 3 articular facets of the talus
anterior, middle, posteriorw
with what do the articular facet articulate with to form subtalar joints
the facets of the calcaneous
which is the largest tarsal bone
the calcaneous
what is the posterior tuberosity of the calcaneous for
Achilles attachment
what are on the superior side of the calcaneous
the 3 facets (anterior, middle, posterior)
what forms the floor of the sinus tarsi
the calcaaneal sulcus
what is the sustentaculum tali
forms a “shelf” for the middle subtalar joints (middle facet)
what is on the lateral side of the calcaneous
the lateral process and the trochlea
which joints can be seen easily on the axial view of the calcaneous
the middle and posterior subtalar joints
what are the 4 joints of the talus
tibiotalar joint
fibulotalar joint
subtalar joints (3)
talonavicular joint
what is special about the talonavicular joint
it is one of only 3 ball and socket joints in the body
what is at the proximal end of the femur
the head (fovea capitis
what is the slope of the neck of the femur
slopes 15-20 deg posteriorly from the pelvis
what is done with the legs when taking an AP of the pelvis
we turn the legs 15-20 deg inwards to compensate
how do you palpate the greater trochanter
turn leg inwards and outwards
where is the lesser trochanter located on a true AP pelvis
it will be posterior to the femur
where are the femoral trochanters on a proper x table lateral
greater: superimposed on the femoral neck
lesser: posterior to the femoral neck
where are the femoral trochanters on a x table lateral with not enough internal rotation
greater: posterior to the femoral neck
lesser: medial
to neck
what is the angle from the side of the femur to the femoral neck
135 (125 + 10)
how many degrees do you angle in a x table hip
45 degrees from the femoral neck
(135 is 45 away from 180)
what does it prove when you image the femur without being able to see the lesser trochanters
that you are seeing the femoral neck without any foreshortening
what is at the distal end of the femur
medial and lateral femoral condyles
what are the parts of the medial femoral condyle
medial epicondyle
adductor tubercle
where is the adductor tubercle
its on the medial condyle, and very posterior on it
what is part of the lateral femoral condyle
lateral epicondyle
sulcus terminalis
how can you tell apart the femoral condyles
if there’s a bump out the back, that’s the adductor tubercle, so the medial condyle
when can you see the sulcus terminalis
in a lateral view of the femur
which tibial condyle is curved
the medial tibial plateau
which femoral condyle is more distal? by how much?
medial condyle
by 5-7 degrees
what angle is used for a mediolateral knee
5-7 cephalad
why would we do a x table lateral knee
to show lipohemarthrosis
what is on the anterior surface of the distal femur
trochlear groove (patella articulation)
what is on the posterior surface of the distal femur
intercondylar notch, fossa, or tunnel
what is the white line visible in the middle of a lateral knee
the roof of the tunnel (on the posterior surface)
what does the line at the end of the femur on a lateral view correspond to
, (in a skyline view ex)
what does the little rounded line inside the middle of a lateral knee correspond to
the trochlear groove
which side of the patella is the base (top or bottom)
the top
which side of the patella is the apex
the bottom
what does the patella articulate with
the trochlear groove
what tendon is attached to the patella
the quadriceps ligaments come together to the quadriceps tendon
what makes up the bony pelvis
2 hip bones, sacrum, coccycx
what is the purpose of the pelvis
connects the lower extremity to the axial skeleton
protects lower reproductive organs, GItract,
strong support for the trunk
what are the parts of the hip bone
ilium
ischium
pubis
what is the upper part of the ilium called
the Ala
how is the Ala curved
posterior is most medial, anterior part is most lateral
what is the iliac crest the landmark for
L4
what is ASIS
anterior superior iliac spine
what is the AIIS
anterior inferior iliac spine
which one (ASIS, AIIS) can you palpate
the ASIS
PSIS
posterior superior iliac spine
PIIS
posterior inferior iliac spine
why is the PSIS a landmark
the SI joint is immediately interior to the PSIS
where is the greater sciatic notch
the big groove between the ilium and ischium
why is the greater sciatic notch important
shows it the body is in a true lateral by looking at superimposition
what parts of the hip forms most of the acetabulum
the body of the ilium
what forms the sacral iliac joint
the auricular surface of the ilium forms with the auricular surface of the sacrum
why is the arcuate fossa significant
it separates Ala from body (of ilium)
but more importantly, forms part of the pelvic brim
where does the arcuate line run to and from
from the auricular surface to the pubis
where (directionally) is the ischium
inferior and posterior
when can the ischial spine be seen
when the pelvis is rotated
what do we sit on
the ischial tuberosity (star)
what is the ischial ramus
projects anteriorly and medially
connecting to the inferior pubic ramus
what are the parts of the pubis
superior pubic ramus
body
inferior pubic ramus
what parts of the pubis form the acetabulum
superior pubic ramus
what does the inferior pubic ramus ramus connect to
ischial ramus
what is the pubic arch
the angle between the two inferior pubis rami
what can you tell from the pubic arch
whether the body is male or femal
what is the pectineal line
travels along superior pubic ramus, meets the arcuate line of the ilium
when looking down at a pelvis, wta is the round ‘bowl’ seen
the epelvuc brim
1
body of ilium
3
Ala of ilium
4
arcuate line of ilium
5
iliac crest
10
ASIS
what is the ASIS a landmark for
SI
11
AIIS
14
iliac fossa
21
ischial ramus
25
body of pubis
26
pubic tubercle
28
pubic crest
29
superior pubic ramus
32
inferior pubic ramus
33
obturator foramen
what happens in an RPO position
as we turn to the right, the right Ala becomes much wider, and the left Ala becomes in profile (star)
what happens to the obturator foramen in an RPO
as they turn to the right, the left obturator foramen becomes open
if a right obturator foramen is open, and the left Ala appears wider, which way is the pelvis rotated
LPO
what are the pubic arch angles for males and females, respecively
<90 males
>90 female
what forms the superior part of the acetabulum
the ilium
what forms the posterior part of the acetabulum
ischium
what forms the anterior part of the acetabulum
pubis
what are Judet views for
fractures of the acetabulum
what are the two columns of bones in the Judet views
iliopobic column (anterior)
ilioischial column (posterior)
what is the pelvic brim
boundary line that separates the true pelvis form the false pelvis
what are the five parts that make up the pelvic brim
sacral promontory
aurate lines of ilium
pectineal lines of pubis
pubic crest (or superior part of superior pubic ramus)
superior part of pubic symphysis (NOT a bony part)
what is the pelvic brim
the entrance to the true pelvis
what is in the false pelvis
superior mart of bladder
lower intestines
uterus, ovaries, fallopian tubes
what is the false pelvis bound by
lumbar spine, Ala, anterior abdominal wall
what is the true pelvis bound by
sacrum/coccyx, body of ilium, ischium, pubic bones
what does the true pelvis contain
rectum, bladder, prostate/vagina/cervix
what forms the pelvic inlet
the same things that forms the pelvic brim
what is the pelvic outlet
the inferior opening of the true pelvis
what is the pelvis outlet bounded by laterally
between the ischial tuberosities
what is the AP diameter of the pelvic outlet
tip of coccyx to inferior margin of pubic symohysis
what do you do for pubic bone fractures
inlet and outlet views
what do you do for acetabulum fractures
Judet views
what angle is used for a inlet view
40 degrees caudad
what angle is used for a pelvic outlet view
30 degrees cephalad
what are the differences between female and male pelves
females have a larger true pelvis (inlet and outlet)
females have a shallow false pelvis, males have a deep false pelvis
female have a pubic arch greater than 90 degrees
what determines the width of the pelvic inlet
the width of the arcuate lines on the ilium
what are the 3 calcaneal articulations
subtalar/talocalcaneal joints (3)
calcaneonavicular joint
calcaneocuboid joint
where is the calcaneonavicular joint
on the anterior process of the calcaneous
what are the navicular articulations (3)
calcaneonavicular joint
talonavicular joint
all 3 cuneiforms
what are the cuboid articulations (4)
calcaneocuboid joint
joint between cuboid and lateral cuneiform
TMT joints (w4/5 metatarsals)
navicular
what are the 3 cuneiform articulations
medial cuneiform
intermediate cuneiform
lateral cuneiform
what is the medial cuneiform joint
TMT joints with great toe
what is the intermediate cuneiform joint
TMT joints with 2nd toe
what is the elateral cuneiform joint
TMT joints with 3rd toe
what lines up in the cuneiform joints?
the medial part of the cuneiforms must line up with the medial aspect of the metatarsals
what are 2 properties of longitudinal arches
shock absorber
provides leverage while walking
what forms the longitudinal arches
tarsal and metatarsal bones
what are the 2 longitudinal arches
medial longitudinal arch and lateral longitudinal arch
which longitudinal arch is higher
medial
where is the medial longitudinal arch
originates at the calcaneous
rises to the talus
ends at the heads of the first 3 metatarsals
where is the lateral longitudinal arch
originates at the calcaneous
rises to cuboid
ends at the head of the lateral 2 metatarsals
what forms the transverse arch
3 cuneiforms, cuboid, bases of all 5 metatarsals
what are the 2 major bones of the lower leg
tibia and fibula
tib/fib which is more medial
tibia
tib/fib which is more posterior
fibula
where is the tibial plateau
on the proximal part of the tibia
what forms the tibial plateau
medial and lateral condyles
where is the facet in the tibial plateau
posterolateral surface
which tibial condyle is curved form anterior to posterior
medial
what direction is the slope of the proximal tibia
posterior slope
what separates the tibial condyles
intercondylar eminences
what is the tibial tuberosity
the attachment for the patellar ligament
what is a part of the distal tibia (4)
medial malleolus
fibular notch
anterior tubercle
tibial plafond
where is the fibular notch
the lateral side of the distal tibia
what is the ankle mortise
refers to the bony arch formed between the tibial plafond and malleoli
what is on the distal tibia
posterior malleolus
what does the head of the fibula articulate with
lateral condyle of the tibia
what is the anterior/posterior difference between the 2 malleoli?
the lateral malleolus is 15-20 degrees more posterior
what is the longest, strongest, heaviest bone?
the femur
what is the intertrochanteric line
joints the femoral trochanters anteriorly
what is the intertrochanteric crest
a ridge that joints the femoral trochanters posteriorly
what is the anterior join of the femoral trochanters
intertrochanteric line
what is the posterior join of the femoral trochanters
intertrochanteric crest
what is the linea aspera
ridge on the posterior femur, site for muscle attachment
