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MRCS extra > Lower limb > Flashcards

Lower limb Flashcards

1
Q

Borders of the femoral triangle

A

superior - inguinal ligament

lateral - medial border of sartorius

medial - medial border of adductor longus

floor - pectineus, iliopsoas and adductor longus

root - fascia lata

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2
Q

Content of femoral triangle

A

Femoral nerve

Femoral artery

Femoral vein

Femoral lymph nodes/canal

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3
Q

What is the femoral sheath?

A

Continuation of the fascia lining the abdomen

Anterior wall - continuous with fascia transversalis

Posterior wall - continous with fascia iliaca.

Sheath surrounds the femoral vessels and lymphatics for about 2.5cm below the inguinal ligament.

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4
Q

Content of femoral sheath

A

Femoral artery, vein and canal

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5
Q

Borders of Femoral canal (femoral ring)

A

Small medial compartment of the femoral sheath.

At the superior aspect is called the femoral ring:

Roof - inguinal ligament

lateral - femoral vein

medial - lacunar ligament

floor - pectineal ligament

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6
Q

Content of femoral canal

A

lymph nodes (femoral hernia)

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7
Q

How does a femoral hernia present?

A

Femoral hernia get hernial sac passing down femoral canal pushing septum (forms opening of femoral ring) before it

When passes out of bottom end of femoral canal forms a swelling in upper part of thigh deep to fascia

Swelling will lie below and lateral to pubic tubercle

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8
Q

Borders of adductor canal/hunter’s canal

A

Runs from apex of femoral artery to opening in adductor magnus.

Floor - adductor longus and magnus

Lateral - vastus medialis extends from the apex of femoral triangle to adductor hiatus

Sup: from apex Fem triangle

Inferiorly - adductor hiatus in adductor magnus

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9
Q

Content of adductor canal / hunter’s canal

A

Femoral artery

Femoral vein

Saphenous nerve

Terminal part of obturator nerve

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10
Q

Borders of Popliteal fossa

A

Inferior - 2 heads of gastrocnemius and plantaris

Lateral - biceps femoris

Medial - semimembranosus floor - posterior joint capsule

Roof - popliteal fascia

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11
Q

Content of popliteal fossa

A

popliteal artery

popliteal vein

tibial nerve

common peroneal nerve

Popliteal lymph nodes

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12
Q

What is the relationship of structures at the popliteal fossa?

A

Tibial and common fibular nerves (follows biceps femoris tendon) - superficial

Small saphenous vein

Deepest structure is the popliteal artery

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13
Q

Hip joint

A

Ball and socket joint, articular cartilage

Acetabulum (pubis, ischium, ilium) and femoral head

3 ligaments:

  • *Pubofemoral** (superior pubic rami to intertrochanteric line)
  • *Ischiofemoral** (ischium to greater trochanter) - weaker point
  • *Iliofemoral** (AIIS to intertrochanteric line) - strongest point ligament of head of femur (contains a branch of obturator artery)
medial circumflex
femoral artery (branch of profunda femoris) supplies the femoral head
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14
Q

What does the sacrotuberous ligament connect?

A

Connects the back of the sacrum to the ischial tuberosity

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15
Q

What does the sacrospinous ligament connect?

A

Connects back of sacrum to spine of ischium

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16
Q

Hip muscles - superficial abductors and extensors

A

Gluteus maximus

Gluteus medius

Gluteus minimus

Tensor Fascia Lata

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17
Q

Gluteus maximus

A

origin - posterior surface of Ilium, sacrum, coccyx

insertion - Gluteal tuberosity of the femur, fascia lata

innervation - inferior gluteal nerve action

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18
Q

Gluteus medius

A

origin - iliac crest

insertion - lateral surface greater trochanter of femur

innervation - superior gluteal nerve

action - abductor, internal rotation

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19
Q

gluteus minimus

A

Origin- ilium

insertion - anterior greater trochanter of femur

innervation - superior gluteal nerve action - abductor hip, internal rotation

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20
Q

Tensor fascia lata

A

origin - anterior iliac crest, ASIS

insertion - iliotibial band ( which extends to popliteal fascia, lateral condyle of tibia)

innervation - femoral nerve

action - abductor and internal rotation

Role in tensing FASCIA LATA

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21
Q

Attachment of fascia lata

A

Posterior - sacrum and coccyx

Lateral - iliac crest

Anterior - inguinal ligament, superior pubic rami

Medial - Ischiopubic rami, ischial tuberosity , sacrotuberous ligament

Distally - lateral tibial condyle

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22
Q

What is the role of the fascia lata in the leg?

A

Gives rise to three intermuscular septa that attach centrally to the femur.

The septa divide the thigh musculature into three compartments;
anterior
medial
lateral

The lateral intermuscular septum is the strongest of the three due to reinforcement from the iliotibial tract

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23
Q

Hip muscles - deep lateral rotators

A

Piriformis

Gemelli

Obturator internus

Quadratus femoris

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24
Q

Piriformis

A

origin - anterior surface of sacrum

insertion - greater trochanter of femur

innervation - nerve to piriformis

action - lateral rotation, abduction passes through the GREATER sciatic foramen

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25
Q

Gemellus superior and inferior

A

origin - ischial spine and inferior from ischial tuberosity

insertion - greater trochanter of femur

innervation - nerve to obturator internus and quadratus femoris

action - lateral rotation

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26
Q

Obturator internus

A

origin - Internal surface of obturator membrane and posterior bony margins of obturator foramen

insertion - greater trochanter of femur

innervation - nerve to obturator internus

action- lateral rotation passes through the LESSER sciatic foramen

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27
Q

Quadratus femoris

A

origin - Ischial tuberosity

insertion - quadrate tuberosity on the intertronchanteric line

innervation - nerve to quadratus femoris

action - lateral rotation

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28
Q

Contents of greater sciatic foramen

(Suprapiriform and infrapiriform)

A

Supra Piriform foramen
Superior gluteal artery, vein and nerve

Piriformis

  • *Infrapiriform foramen**
  • *P** osterior cutaneous nerve of thigh
  • *I** nferior gluteal artery and nerve
  • *N** erve to quadratus femoris
  • *P** udenal nerve
  • *I** internal pudenal artery and vein
  • *N** erve to obturator internus
  • *S** ciatic nerve
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29
Q

Content of lesser sciatic foramen

A

Pudendal nerve

Internal pudendal vessels

Nerve of obturator internus

Tendon Obturator internus

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30
Q

Greater sciatic foramen

A

Anterolaterally - greater sciatic notch of ilium

Posteromedially - sacrotuberous ligament

Inferiorly - Sacrospinous ligament

Superiorly - anteriror sacroiliac ligament

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31
Q

Lesser sciatic foramen

A

Anterior - tuberosity of ischium

Superior - sacrospinous ligament

Posterior - sacrotuberous ligament

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32
Q

Anterior compartment of thigh

A
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33
Q

Iliacus

A

origin - anterior surface of Ilium

insertion - lesser tubercle of femur

innervation - femoral nerve

action - flexor

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34
Q

Psoas major

A

origin - Transverse process of L2-4

insertion - lesser tubercle of femur innervation - L1-L3

action - flexor

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35
Q

Vastus lateralis

A

origin - greater trochanter and lateral lip of linea aspera

insertion - patellar tendon

innervation - femoral nerve

action - knee extensor

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36
Q

Vastus intermedius

A

origin - anterior and lateral surface of femoral shaft

insertion - patellar tendon

innervation - femoral nerve

action - knee extensor

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37
Q

vastus medialis

A

origin - intertrochanteric line and medial lip of linea aspera

insertion - patellar tendon

innervation - femoral nerve

action - knee extensor

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38
Q

Rectus femoris

A

origin - Acetabulum and AIIS

insertion - patellar tendon

innervation - femoral nerve

action - hip flexor and knee extensor

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39
Q

Sartorius

A

origin - ASIS

insertion - Superior medial surface of tibia

innervation - femoral nerve

action - hip flexor, lateral rotation, knee flexor

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40
Q

Pectineus

A

origin - Pectineal line on the anterior surface of pelvis

insertion - pectineal line inferior to lesser trochanter

innervation - femoral nerve

action - adduction and hip flexion

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41
Q

Muscles in the medial compartment of the thigh

A
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42
Q

Adductor magnus

A

origin - inferior pubic rami & ischial tuberosity

insertion - linea aspera, adductor tubercle/medial supracondylar line of femur

innervation - obturator and tibial

action - adduction

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43
Q

Adductor longus

A

origin - pubis

insertion - linea aspera

innervation - obturator nerve

action - adduction, medial rotation

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44
Q

Adductor brevis

A

origin - pubis and inferior pubic rami

insertion - linea aspera

innervation - obturator

action - adduction

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45
Q

Obturator externus

A

origin - obturator membrane

insertion - greater trochanter

innervation - obturator

action - lateral rotation

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46
Q

Gracilis

A

origin - inferior rami and body of pubis

insertion - medial surface of tibia, between sartorius and semitendinosus

innervation - obturator

action - adduction, flexion of knee

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47
Q

Muscles of posterior compartment of thigh

A

Bicep femoris

Semimembranosus

Semitendinosus

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48
Q

Biceps femoris

A

origin - Ischial tuberosity (long head), short head = linea aspera

insertion - Head of fibula

innervation - short head : common fibular nn, long head: tibial portion sciatic nn

action - flexion of knee

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49
Q

Semimembranosus

A

origin - ischial tuberosity

insertion - medial tibial condyle

innervation - sciatic nerve/tibial

action - flexion of knee

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50
Q

Semitendinosus

A

origin - ischial tuberosity

insertion - medial surface of tibia

innervation - sciatic nerve/tibial

action - flexion of knee

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51
Q

Proximal Femur

A

Head - joint with acetabulum with ligament teres

Neck - common fracture line

Greater trochanter - gluteal, lateral rotators

Lesser trochanter - hip flexors intertrochanteric line = becomes pectineal line posterior to lesser trochanter

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52
Q

Shaft of femur

A

Linea aspera - attachment of adductor muscles

Gluteal tuberosity

Medial supracondylar line = adductor tubercle

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53
Q

Distal femur

A

Condyles - articular surface of knee joint

Epicondyles - attachment for ligaments and muscles

Intercondylar fossa - ACL (lateral), PCL (medial)

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54
Q

Knee joint

A

Hinge joint, synovial joint

Joint capsules Bursa = Infrapatella, Suprapatella, subpatella, semimembranosus bursa

Ligaments - medial collateral (semimembranosus lies underneath), lateral collateral, ACL/PCL, patellar

Meniscus - medial C shaped (attached to medial collateral), lateral circular

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55
Q

Anterior compartment of the lower leg

A

Tibialis anterior

Peroneus tertius

Extensor hallucis longus

Extensor digitorum longus

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56
Q

Tibialis anterior

A

origin - lateral surface of tibia

insertion - medial cuneiform and 1st base of MTP

innervation - deep peroneal

action - dorsiflexion, inversion

57
Q

Peroneus longus

A

origin - medial surface of fibula

insertion - 1st MTP medial side

innervation - deep peroneal

action - dorsiflexion, eversion

58
Q

Extensor hallucis longus

A

origin - fibula shaft

insertion - Distal phalanx of big toe

innervation - deep peroneal

action - dorsiflexion

59
Q

Extensor digitorum longus

A

origin - lateral condyle of tibia and medial surface of fibula

insertion - distal phalanx

innervation - deep peroneal

action - dorsiflexion

60
Q

Lateral compartment of lower leg

A

Peroneus longus

Peroneus brevis

61
Q

Peroneus longus

A

origin - lateral surface of fibula and lateral tibial condyle

insertion - medial cuneiform and base of 1st MTP

innervation - superficial peroneal nerve

action - eversion, plantar flexion

62
Q

Peroneus brevis

A

origin - shaft of fibula

insertion - tubercle of 5th MTP

innervation - superficial peroneal nn

action - everision

63
Q

Posterior compartment of leg - Superficial

A

Plantaris

Soleus

Gastrocnemius

64
Q

Plantaris

A

origin - lateral supracondylar line of femur

insertion - achilles tendon

innervation - tibial nerve

action - plantar flexion

65
Q

Soleus

A

origin - soleal line of tibia and proximal fibula

insertion - achilles tendon

innervation - tibial nerve

action - plantar flexion

66
Q

Gastrocnemius

A

origin - medial and lateral condyle of femur

insertion - achilles tendon

innervation - tibial nerve

action - plantar flexion, knee flexor

67
Q

Posterior compartment of lower leg - Deep

A

Tibialis posterior

Flexor hallucis longus

Flexor digitorum longus

Popliteus

68
Q

Tibialis posterior

A

origin - Interosseous membrane

insertion - navicular and medial cuneiform

innervation - tibial nerve

action - plantar flexion, inversion

69
Q

flexor digitorum longus

A

origin - medial surface of tibia

insertion - distal phalanx

innervation - tibial nerve

action - plantar flexion

70
Q

flexor hallucis longus

A

origin - posteriro surface of fibula

insertion - distal phalanx of big toe

innervation - tibial nerve

action - plantar flexion

71
Q

Popliteus

A

origin - Posterior surface of tibia

insertion - lateral condyle of femur, lateral meniscus

innervation - tibial nerve

action - laterally rotates knee for UNLOCKING

72
Q

Patella

A

SESSAMOID BONE patellafemoral groove

patellofemoral articulation thus part of knee joint

Enhances the extension of knee by quadriceps

73
Q

Tibia

A

Medial bone in lower leg

Weight bearing bone

Patella ligament attaches to TIBIAL TUBEROSITY

Posterior surface - SOLEAL LINE

74
Q

Fibula

A

Lateral bone of lower leg attaches to the lateral condyle of tibia

Posterior, lateral surface lies the common peroneal nerve at the fibular neck

Forms the lateral malleolus

75
Q

Tarsal bones

A

Talus

Calcaneus

Navicular

Cuboid

3 cuneiforms

76
Q

Joints of talus bone

A

3 articulations

Ankle joint

subtalar joint - calcaneus

talonavicular joint Fracture can lead to AVN

77
Q

Joints of Calcaneus

A

2 articulations

Subtalar joint

Calcaneocuboid joint

78
Q

Pott’s fracture dislocation

A
79
Q

Segond fracture

A

avulsion fracture of the lateral tibial plateau with ACL injury

80
Q

Osgood schlatter disease

A

chronic avulsion fracture of tibial tuberosity where the patella ligament inserts

81
Q

Maisonneuve fracture

A

Spiral fracture of proximal fibula

Tilofibular syndesmosis/deltoid ligament disruption/medial malleolus fracture

82
Q

Jones fracture

A

extra articular fractue of base of 5th MTP

83
Q

Subtalar joint

A

plane synovial joint

Posterior talar articular surface and posterior calcaneal articular facet

Joint capsule 3 ligaments - posterior/medial/lateral talocalcaneal ligament

Interosseous talocalcaneal ligament

84
Q

Muscles in the dorsum of the foot

A

Extensor hallucis brevis

Extensor digitorum brevis

85
Q

Extensor hallucis brevis

A

origin - calcaneus and extensor retinaculum

insertion - proximal phalanx of big toe

innervation - deep peroneal nerve

action - extend great toe at MTP

86
Q

Extensor digitorum brevis

A

origin - calcaneus and extensor retinaculum

insertion - long extensor tendons

innervation - deep peroneal nerve

action - extension at MTP, IPJ

87
Q

Muscles of foot - plantar 1st layer

A

Abductor hallucis

FLexor Digitorum brevis

Abductor digiti minimi

88
Q

Abductor hallucis

A

origin - calcaneus, flexor retinaculum and plantar aponeurosis

insertion - medial base of proximal phalanx

innervation - medial plantar nerve

action - abduct the big toe

89
Q

Flexor digitorum brevis

A

origin - calcaneus, plantar aponeurosis insertion - middle phalanges of toes innervation - medial plantar nerve action - flex PIPJ

90
Q

Abductor digiti minimi

A

origin - calcaneus, plantar aponeurosis

insertion - proximal phalanx of 5th digit

innervation - lateral plantar nerve

action - abduct 5th toe

91
Q

Muscles of the foot 2nd layer

A

Quadratus plantae

Lumbricals

92
Q

Quadratus plantae

A

origin - calcaneus

insertion - FDL tendons

innervation - lateral plantar nerve

action - assist FDL

93
Q

Lumbricals

A

origin - tendons of FDL

insertion - extensor hood of lateral four digits

innervation - medial/lateral plantar nerve

action - flexes MTPJ extends IPJ

94
Q

Muscle of the foot 3rd layer

A

Flexor hallucis brevis

Adductor hallucis

Flexor digiti minimi brevis

95
Q

Flexor hallucis brevis

A

origin - Cuboid and lateral cuneiforms

insertion - proximal phalanx of big toe

innervation - medial plantar nerve

action - flexes MTPJ

96
Q

Adductor hallucis

A

origin - oblique head (2-4th MTP) and plantar ligaments of MTPJ

insertion - lateral base of proximal phalanx of big toe

innervation - lateral plantar nerve

action - adduct toe

97
Q

Flexor digiti minimi brevis

A

origin - base of 5th MTP

insertion - base of proximal phalanx of 5th

innervation - lateral plantar nerve

action - flexion of 5th toe

98
Q

Muscles of the foot 4th layer

A

Plantar and dorsal interossei

Only 3 plantar interossei, 4 dorsal interossei

innervation - lateral plantar nerve

action - Dorsal - ABDUCT, plantar - ADDUCT

99
Q

Order of structures at medial malleolus

A
100
Q

branches of internal iliac artery in lower limbs

A

I Love Going Places In My Very Own Underwear

I: iliolumbar artery

L: lateral sacral artery

G: gluteal (superior and inferior) arteries

P: (internal) pudendal artery

I: inferior vesical (vaginal in females) artery

M: middle rectal artery

V: vaginal artery (females only)

O: obturator artery

U: umbilical artery and uterine artery (females only)

The first three branches in the mnemonic (iliolumbar, lateral sacral and superior gluteal) are branches of the posterior division of the internal iliac artery, the remaining branches are of the anterior division.

101
Q

Femoral artery

A

Arises after inguinal ligament

Enters femoral triangle and ends at opening in adductor magnus muscle.

Branches:

  • *Profunda femoris** (which gives rise to medial and lateral circumflex femoral arteries)
  • *Genicular artery** - supplies the knee joint
102
Q

popliteal artery

A

arises after adductor hiatus

Branches at knee then:

anterior tibial artery (dorsalis pedis)
Tibioperoneal trunk (posterior tibial and peroneal)
103
Q

Course of femoral vein?

A

Enters thigh by passing through opening in adductor magnus (continuation of the popliteal vein)

Lies lateral to artery then posterior to artery then medial

104
Q

Veins in the legs - deep

A

Anterior tibial vein

Posterior tibial vein

popliteal vein -

femoral vein

105
Q

Superficial vein of legs

A

Great saphenous vein - medial aspect of leg, anterior to medial malleolus (closely accompanied by saphenous nerve)

Small saphenous vein - lateral aspect of leg - posterior to lateral malleolus, joins the popliteal vein

106
Q

Course of the posterior tibial artery

A

Begins at lower level of popliteus muscle and passes downwards deep to gastrocnemius and soleus

Lies on posterior surface of tibialis posterior (lies lateral to medial malleolus as above)

Terminal branches are medial and lateral plantar arteries

107
Q

What is the course of the anterior tibial artery?

A

Arises at lower level of popliteus muscle

Passes forward into anterior compartment of leg through an opening in the upper part of the interosseous membrane (accompanied by deep peroneal nerve)

At ankle joint:

  • *Medial:** Tendon of EHL
  • *Lateral side:** Deep peroneal nerve & EDL
108
Q

What is in the lumbar plexus & what nerves originate there?

A

Formed in the psoas muscle from the anterior rami of upper 4 lumbar nerves

I (twice) get laid on friday
All lateral other than genitofemoral (ant) and obturator (medial)

Iliohypogastric

Ilioinguinal

Genitofemoral nerve (anterior)

Lateral cutaneous nerve of thigh

Obturator nerve (medial)

Femoral nerve

109
Q

What are the nerve root values of the lumbar plexus?

A

I (twice) Get Laid On Fridays - nerves

2 from 1, 2 from 2, 2 from 3

Iliohypogastric (L1)
Ilioinguinal (L1)
Genitofemoral (L1, L2)
Lateral cutaneous nerve of thigh (L2, L3)
Obturator (L2, 3, 4)
Femoral (L2 , 3, 4)

110
Q

Iliohypogastric nerve

A

Origin: L1

Pierces internal and external oblique internal oblique

Innervates internal and transverse abdominal muscles.

111
Q

Ilioinguinal nerve

A

Origin: L1

Perforates transversus abdominis then accompanies spermatic cord (males) or round ligament of the uterus (females) through the superficial inguinal ring.

Supplies:
Male: Skin of the root of the penis and adjacent part of the scrotum

Female: Skin covering mons pubis and labia majora

NS does NOT pass through the deep inguinal ring therefore only travels through part of the inuinal canal.

112
Q

Obturator nerve

A

L2-L4

Supplies the medial compartment (adductor) of the thigh

Skin - medial thigh

Passes through the obturator foramen

113
Q

Femoral nerve

A

L2-L4

Supplies the anterior compartment of the thigh (thigh muscles that flex the hip joint and extend the knee.)
Anterior aspect of thigh

Gives off saphenous nerve -> supplies sensation to medial side of leg and foot.

114
Q

Genitofemoral nerve

A

L1-L2

Cremasteric muscle

Skin over the anterior part of scrotum, labia majora

115
Q

Lateral cutaneous nerve of the thigh

A

L2-L3

Enters thigh at end of inguinal ligament

Supplies skin at lateral aspect of thigh and knee

116
Q

What is the sacral plexus formed from?

A

L4, 5 S1, 2, 3, 4

On anterior surface of piriformis muscle

  • *superior gluteal nerve** L4/5 S1
  • *Inferior gluteal** L5 S1/2
  • *Posterior femoral cutaneous** S1/2/3
  • *Pudendal** S2/3/4
  • *Sciatic** L4, 5, S1, S2, S3
117
Q

What is the route of the superior gluteal nerve?

A

L4, 5, S1

Passes superior to the piriformis via the greater sciatic foramen

Accompanied bu sup. gluteal vein and artery

118
Q

What is the course of the inferior gluteal nerve?

A

L5, S1, S2

Leaves pelvis via greater sciatic foramen inferior to piriformis muscle

Motor function - gluteus maximus

119
Q

What is the route of sciatic nerve

A

L5 - S3

2 components:

  • *Fibular** (dorsal division L4 - S2)
  • *Tibial** (ventral divisions L4 - S3)

Formed on anterior aspect of piriformis muscle

120
Q

What muscles are innervated by the tibial componenet of the sciatic nerve?

A

Muscles in:
Posterior compartment of thigh (other than SH of Biceps femoris - innervated by fibular portion of sciatic nerve)
Hamstring component of adductor magnus
Posterior compartment of leg
Muscles in sole of foot

121
Q

What muscles are innervated by fibular portion of sciatic nerve?

A

Short head of biceps femoris
Anterior and lateral compartments of the leg & extensor digitorum brevis muscle

122
Q

Common peroneal nerve

A

L4-S3

Runs downward through the popliteal fossa closely following medial border of biceps femoris

Leaves fossa by superficially crossing lateral head of gastrocnemius muscle

Passes behind fibula winds around neck goes through deep peroneous longus and divides into:
Superficial peroneal nerve
Deep peroneal nerve

123
Q

Where can the common peroneal nerve be damaged and what are the clinical finidings

A

Extremely vulnerable to injury as it winds around the neck of the fibula

At this site is exposed to direct trauma

124
Q

Deep peroneal nerve

A

L4/L5

Arises from common peroneal nerve
Enters anterior compartment of the leg

Initially lies lateral to ant. tibial artery, than anterior than lateral

Supplies:

  • *Sensory:** web of 1st and 2nd toe
  • *Motor:** Anterior compartment of leg
125
Q

Superficial peroneal nerve

A

L4-S1

Arises at the lateral neck of fibula

Descends between peroneus longus and brevis

Muscular branches: peroneus longus & brevis
Cutaneous branches:
Supply dorsal surface of all toes other than 1st web space

126
Q

What is the origin / route of the posterior cutaneous nerve of the thigh?

A

S1, 2, 3

Leaves pelvis via greater sciatic foramen. Enters inferiorly to piriformis muscle

Runs down back thigh to knee

Innervates skin of perineum, posterior surface thigh and leg.

127
Q

Origin of the pudenal nerve & root?

A

S2, 3, 4

Leaves via greater sciatic foramen and then loops around sacrospinus ligament to enter pelvis via lesser sciatic foramen

Motor: Innervates EUS, EAS, levator ani muscle

Sensory: Innervates penis, clitorus and nerves of skin

128
Q

Sural nerve

A

from common peroneal and tibial nerve cutaneous branch for lateral malleolus

129
Q

In compartment syndrome what is the order of symptoms?

A

pain w/ passive stretch

paresthesia and hypoesthesia (indicative of nerve ischemia in affected compartment)

paralysis

peripheral pulses absent (amputation is inevitable)

130
Q

What is the classification of ankle fractures and what is it based on?

A

Weber’s classification

It is based on the relation of the fracture to the syndismosis.

131
Q

Describe the classification of ankle fractures & mechanism of injury?

A

Weber’s:

A: sub syndismosis
Mechanism: SAD (supination and adduction)

B: syndismotic
Mechanism: SEX (supination and external rotation)
OR
PAB (pronation and abduction)

C: supra syndismotic
Mechanism: PEX (pronation external rotation)

132
Q

What type of # is this?

A

Weber B

133
Q

What type of # is this?

A

Weber A

134
Q

What type of # is this?

A

Weber C

135
Q

Describe the stability of the different ankle fractures?

A

Weber’s A = Stable

Weber’s B = Stable/Unstable dependent on whether the deltoid ligament (medial) is intact

Weber’s C = Unstable

136
Q

What is the sensory nerve supply of the leg?

A
137
Q

What position of the leg would you expect in a fracture of the upper 1/3 of the femoral shaft?

A

Leg is shortened and externally rotated.

Proximal fragment is:
Flexed by iliopsoas

Abducted by gluteus medius & minimus

Laterally rotated by gluteus maximus, piriformis, obturator internus, gemelli and uadrator femoris

Distal fragment is:
Adducted & laterally rotated by adductors

Pulled proximally by uads and hamstring

138
Q

What is the displacement seen in a fracture of the middle shaft of femur

A

Distal fragment:

Pulled proximally by hamstrings & uadriceps

Rotated backwards by pull of GASTROCNEMIUS

139
Q

What is the displacement seen in distal 1/3 femur fractures

A

Similar to Middle third of shaft fracture:
Distal fragment:

Pulled proximally by hamstrings & uadriceps

Rotated backwards by pull of GASTROCNEMIUS
NB distal fragment is very small therefore is displaced to a greater extent.
Can impair blood supply of the popliteal artery

MRCS extra (5 decks)

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