Lower Extremity Quiz 1 (Lectures 24-30) Flashcards
Describe the transfer of weight in the lower extremity.
From the Pelvis:
- Hip Joint
- Femur
- Knee Joint
- Tibia
- Ankle Joint
- Foot
What Bone in the lower leg forms the part of the ankle joint?
Fibula
TRUE OR FALSE: The pelvis is fully mature after your teenage years?
True, they complete between the ages of 20-25
What separates the bones of the pelvis at puberty and where are they centered around?
- A Y-shaped cartilage around the acetabulum.
What bony landmark on your body has your body weight rest in the seated position?
The Ischial Tuberosity
What are more common in the hip than fractures and dislocations?
Contusions and Hematomas
What is a common factoring cause for hip fractures and dislocations?
- High-Energy Trauma/Severe-Direct Trauma
A patient falls from a roof and lands on their feet, what can be caused by this lateral compression of the pelvis?
Fracture of the Acetabulum
What is an avulsion fracture?
When there is avulsion or tearing away from the ischial tuberosity.
What can cause an avulsion fracture?
- Adolescents or young adults playing in sports with sudden acceleration and deacceleration.
Do men or women have a greater angle for the head of the femur
Men have a greater angle
Older patients who experience a slight stumble may experience, what fracture?
Femoral neck fracture
What is a Slipped Epiphysis of the Femoral Head? What can cause this to occur in patients?
Occurs in Children/Adolescents; When the femoral head rips off of the femoral neck.
Acute or repetitive micro-traumas.
Characteristics of Slipped Epiphysis of the Femoral Head?
- Initial hip discomfort
- Progressive Coxa Vara
What is Coxa Vara and Coxa Valga?
- Coxa Vara is when the angle of inclination is decreased causing the neck and body of femur to be closer together. This limits passive abduction of the hip and shortens the lower limb.
- Coxa Valga is when the angle is increased, appearance of longer legs.
When an elderly patients claims to have broken a hip, it is more likely that the patient experienced a?
Fracture of the femoral neck
What is there to note about Femoral Neck Fractures?
- Most troublesome fracture
- Very limited in Osteogenesis
- Injuries at this site can lead to ruptures in circumflex medial femoral arteries resulting in necrosis of the femoral head.
What are some other types of femoral fractures?
- Intertrochanteric Fractures
- Petrochanteric Fractures
- Occurs from Violent direct injuries like Automobile Accident
What is the most common site for the fracture of the tibia?
Narrowest site at the junction of the middle and inferior thirds.
Tibia fractures are usually what kind of fractures?
Compound fractures, which are prone to infection due to the skin being perforated and ripped blood vessels.
What is the Transverse Stress Fracture of the tibia?
Fractures the inferior third of the tibia; Common for people who take long walks when they shouldn’t
Whats a diagonal fracture of the Tibia?
Indirect violence applied to the tibial body while it is turning and the foot is fixed in place.
Occurs during a football tackle or skiiing
What is a “Boot-Top fracture”?
A comminuted fracture of the tibia leading to fragments of bone.
What is a “Bumper Fracture”?
A compound fracture from when the bumper of a car directly impacts the tibia, the skin is torn and the bone protrudes.
Are tibial fractures a long or short time to heal?
Long; approximately up to 6 Months.
What location of the tibia is accesible for bone grafting in children?
Anterior tibia
What is Osgood-Schlatter Disease?
Disruption of the epiphyseal plate at the tibial tuberosity in teenagers, resulting in Chronic reoccurring pain.
Most common site for fibular fractures?
2 to 6 cm proximal to the distal end of the lateral malleolus
Features of a lateral malleolus fracture?
Foot is forced into an excessively inverted position tearing the ankle ligaments.
Why is the fibula a great option for bone grafting?
Because when a long piece of fibula is removed, most functions of the leg can be performed properly
What is the supracrestal plane and its significance?
- Highest level of the iliac crest (L4/L5)
- The Landmark for lumbar puncture to obtain CSF
A patient falls from a ladder and lands on their heels? What type of injury can the patient attain?
Calcaneal fracture; a comminuted fracture that has a rich blood supply and is disabling.
Fracture of the Talar Neck occurs when?
During Severe Dorsiflexion of the ankle
When a patient’s foot is SUDDENLY AND VIOLENTLY INVERTED, what injury can occur?
Avulsion fracture of the 5th Metatarsal Tuberosity
Fracture of the Sesamoid Bones of the great toe (Hallux) occur when?
A crushing injury such as a heavy object falling on it.
What is a key difference between Deep and Superficial Fascia?
Deep fascia is responsible for preventing muscles from bulging during contractions.
They also form fibrous septa that separates muscles from one another.
What is the Fascial Inter-muscular Septa?
Separates the thigh muscles into 3 compartments:
1. Anterior
2. Medial
3. Posterior
What is the saphenous opening?
REMEMBER VEINS MOVE FROM DISTAL TO PROXIMAL A ring in the deep fascia that allows the passage for lymphatic vessels and the great saphenous vein to enter into the fascia.
It will then pass through the saphenous opening to enter the femoral vein
What are the two structures that divide the leg and how do they divide the leg?
- Interosseous membrane: Divides the leg into Anterior (Extensor), Lateral (Fibular), and Posterior (Flexor)
2.Transverse intermuscular Septum: Divides the posterior compartment into superficial and deep
What are musculovenous pumps?
They enable muscular contractions to propel blood in the veins towards the heart against the pull of gravity.
What is the concept around varicose veins, thrombosis, and thrombophlebitis?
- Great saphenous vein is dilated and valves become incompetent and cannot compete with the pull of gravity.
- Venous thrombosis occurs (Blood clotting) from fractures and if veins experience inflammation the patient experiences thrombophlebitis.
What is Pulmonary Thromboembolism?
- Obstruction of the pulmonary artery
- Can occur when a blood clot breaks from the lower limb veins and enters the lungs
- Can potentially lead to death
What vein can be used for grafting during coronary arterial bypass?
Saphenous vein
What could the patient experience if the saphenous nerve is severed?
Pain and/or numbness along the medial border of the foot
What nerve supplies the sensation of the thigh anterior to the greater trochanter?
Subcostal T12
What are the branches of the iliophyogastric nerve and what does it divide into, provide the function.
- Lateral Cutaneous Branch: Supplies the skin over the superolateral part of the buttock
-Anterior Cutaneous Branch: Supplies skin superior to the pubis
What part of the skin is sensitive due to the ilioinguinal nerve
Proximal and medial parts of the thigh, groin area
What part of the skin does the lateral femoral cutaneous nerve affect?
- Anterior branch affects the lateral and anterior parts of the thigh
- Posterior branch affects from the greater trochanter down to the area proximal to the knee.
What part of the skin does the anterior femoral cutaneous nerve affect?
Medial and anterior aspects of the thigh
What part of the skin does the obturator nerve supply?
Along with the saphenous nerve it affects the proximal parts of the thigh.
What is a charley horse?
AKA Cricket thigh, comes from a thigh contusion.
What is Genu Varum and Genu Valgum?
Genu Varum is when the knees point outwards when standing (Bowleg)
Genu Valgum is when the knees point inward when standing (Knock-knee)
What is runner’s Knee?
Chondromalacia patellae, a quadriceps imbalance that be seen in sports that overstress the knee.
What is the best type of patellar fracture out of all of them and why?
Vertical fractures as they do not destroy the capabilities to walk or use the knee.
What is a common muscle strain seen in horseback riders?
Strain of the adductor longus
What is a femoral hernia and how does it occur?
- It is a protrusion of the abdominal viscera and appears as a mass.
- Bounded laterally by the femoral vein and medially to the inguinal ligament.
- Hernial sac, which is the compression of the femoral canal.
- In men, more likely than not they experience an indirect inguinal hernia rather than a femoral hernia.
What are the borders of the adductor canal?
- Lateral: Vastus medialis
- Medial: Sartorius
- Posterior: Adductor longus and Magnus
What separates the buttocks from one another?
Intergluteal cleft
- The gluteal sulcus is the little line separating the butt from the thigh
