Lower Limb Anatomy Flashcards
What is the relevant anatomy and clinical relevance of an intra-capsular NoF fracture?
Occurs superior to the intertrochanteric line within the capsular space
May break the medial and lateral circumflex arteries = head of femur no blood supply = necrotic
Ligamentum teres blood supply no longer patent in adults.
Must be removed and replaced
What is the relevant anatomy and clinical relevant of the extra-capsular NoF fracture?
Below the intertrochnateric line
Below supplied by the interosseous blood supply
The head is still supplied by the medial and lateral circumflex arteries = still viable
Ligamentum teres is no longer viable in adults
Requires fixation but hopeful that will heal
Describe the arterial branches and their supplies from the internal illiac artery
The superior gluteal - superficial gluteal muscles
The obturator - medial thigh
The inferior gluteal - deep gluteal muscles
Describe the arterial branches of the external illiac artery
The femoral artery
1) Branch of profunda femoris with medial and lateral circumflex branches and perforating branches (NoF and anterior thigh)
Continues as the popliteal artery (with geniculate anastomosis)
1) the anterior tibial artery - continues to become the dorsalis pedis
2) the posterior tibial artery - continues to give off the fibular artery.
What is the anatomical border between the external iliac and the femoral artery?
The inguinal ligament
What is the anatomical border between the femoral and popliteal artery?
The adductor hiatus (within adductor magnus muscle)
What is the relevant venous drainage of the lower limb?
Deep = same as arterial
Superficial:
The small saphenous = drain into popliteal vein
The great saphenous = drain into femoral vein
What are the key different fracture types?
Compound - pierces the skin
Comminuted - more than 2 places of break
Segmented - two break areas - results in one portion of bone in the middle separated from the rest
Displaced
Spiral
Greenstick - only partial width break in the bone.
Evulsion - break away of portion of bone attached to ligament or tendon
What are the different bony sections of a long bone?
Epiphysis - very top and bottom
Metaphysis - the neck region
Diaphysis - the shaft
The articular surface
What local structures related to the knee joint can be used in ACL replacement surgery?
Semitendinosus tendon
Patella tendon
Collateral ligaments
What are some signs of osteoarthritis seen on imaging?
Osteophytes
Cartilage degradation
Subarticular sclerosis
Joint space Narrowinh
What are some risk factors for oesteoarthiritis?
Smoking
Obesity
Age
Previous injury
What are some potential risks of a femoral nerve block?
Vascular puncture
Neuritis
Femoral nerve compression by hematoma
Post-operative falls (due to muscle weakness)
Femoral nerve neuropathy
What is the cutaneous innervation of the ilioinguinal nerve?
Skin over anteriomedial part of upper thigh and adjacent peritoneum
What is the cutaneous innervation of the genitofemoral nerve?
Femoral branch -> anterior/central upper thigh
Genital branch -> anterior perineum
What is the cutaneous innervation of the femoral nerve?
Skin of anterior thigh
Anteriomedial knee
Medial leg
Medial foot
What is the cutaneous innervation of the obturator nerve?
Upper medial aspect of the thigh
What is the cutaenous innervation of the sciatic nerve?
Lateral Leg and Foot
Sole and dorsal foot
What is the cutaneous innervation of the lateral cutaneous nerrve of thigh?
Parietal peritoneum in iliac fossa, skin over anterolateral thigh
What is the cutaneous innervation of the posterior cutaneous nerve of the thigh?
Skin over gluteal fold and upper medial aspect of thigh and adjacent perineum
Posterior thigh
Upper posterior leg
What is the cutaneous innervation of the perforating cutaneous nerve?
Skin over medial aspect of gluteal fold
What are the borders of the femoral triangle?
Inguinal ligament
Sartorius
Adductor longus
Roof = fascia lata -> with saphenous opening
Floor = body of adductor longus, pectineus, iliopsoas
What is the femoral sheath and femoral canal?
Sheath - in the femoral triangle - surrounds the femoral artery, vein and deep inguinal lymph nodes
Canal - contains singular femoral lymph node - in association with the sheath
Where is the midinguinal point and why is it important clinically?
Halfway between the ASIS and the pubic symphysis
Palpation of the femoral artery
Where is the midpoint of the inguinal ligament and why is it important clinically?
Halfway between the ASIS and the PT
For femoral nerve block
What is the name given to the ligament at the head of the femur?
Ligamentum teres
What is the acetablum labrum and what is its purpose?
Hip osteology
Fibrocartilage ring attachment of the hip joint/acetabulm
Reduces friction/inc smooth movement, increases stability, shock absoprtion
How does the strength of the hip ligaments vary?
Weakest = ischiofemoral
Pubofemoral
Strongest = iliofemoral
When is each hip ligaments tense?
Iliofemoral - during hip extension (prevents hyperextension when standing)
Pubofemoral - when extending or abducting (prevents hyper)
Ischo -internrotation and adducting
In a NoF fracture what muscle causes the foot to present shortened and externally rotated
Iliopsoas
What muscles and innervation provides internal rotation of the hip?
gluteus medius, gluteus minimus and tensor fasciae latate - superior gluteal nerve
(Adductors may also help)
What muscles and innervation help externally rotate the hip?
gluteus maximus is the most powerful (inferior gluteal nerve), piriformis, SG, OI, IG, quadratus femoris - superior gluteal nerve?? Iliopsoas - femoral nerve
In what direction are hip dislocations the most common?
Why?
Posterior (85%)
Mechanism of injury - car crah - hip flexed, adducted and internally rotated
Anatomy - the ischiofemoral ligament is weaker than the iliofemoral ligament
What structures are at risk following a hip dislocation?
The sciatic nerve
The labrum
Soft tissue surrounding joint - gluteus medius, rectus femoris and short deep rotators of the hip
The femoral artery, vein and nerve
What is a Trendelenburg sign?
Positive test
Weak hip abductors (gluteus medius and minimus muscles) - when stance leg/weight bearing - cause hip drop on the contralateral side
What is the common complications of a fracture neck of the femur?
Avascular necrosis of the femoral head
What is a surgical treatment for an arthritic hip?
Hip arthoplasty
What is this line?
How is it useful?
If the line is not smooth indicaites hip joint abnormalities - dislocations, fractures, subluxation, dysplasia
