Lower Limb

Question 1

How do you do a two incsion fasciotomy and what are the dangers?

Answer 1

posterolateral incision between fibula and tibial crest

posteromedial incision 2cm posterior tibial edge

dangers laterally is the SPN and medial is the Posterior NV bundle when dissecting the deep posterior compartment

Question 2

What is the deformity and the deforming muscles for a proximal ⅓ tibial fracture?

What are the muscles responsible?

Answer 2

Varus procurvatum

extension (procurvatum) patellar tendon

flexion of distal segment - hamstrings

valgus - pes and anterior compartment musculature

Question 3

Where would you put blocking screws to help with nailing a proximal 1/3 tibial fracture?

What are 4 other reduction techniques you can use?

Answer 3

Posterior and lateral in the proximal segment

4 other reduction techniques:

• suprapatellar start point
• open reduction
• unicortal plating
• external fixation
• femoral distractor
• ‘F’ reduction tool
• manual traction

Question 4

Where does the peroneal nerve exit from under the biceps and where is it apposed to the fibula?

Answer 4

It exits from beneath the biceps approximately 6 cm proximal to the fibular head. This distance decreases with knee flexion (Fibular Head as a Landmark for Identification of the Common Peroneal Nerve: A Cadaveric Study)

It wraps around the fibula approximately 3-4cm from the tup of the fibular head.

Question 5

What is the double PCL sign?

Answer 5

• this is when there is an incarcerated bucket handle tear

Question 6

Name the OINA of all the muscles of the hip - see list in answers

Answer 6

Good luck