Lower limb anatomy / fractures

Question 1

where does the femoral artery branch from

Answer 1

external iliac

Question 1

where does the obturator artery branch from

Answer 1

internal iliac

Question 2

what does the femoral nerve (L2-L4) supply

Answer 2

hip flexors and knee extensors

Question 3

what does the obturator nerve (L2-L4) supply

Answer 3

medial muscles (the adductors)

Question 4

nerve roots of sciatic nerve

Answer 4

L4-S3

Question 5

where does the sciatic nerve supply

Answer 5

posterior thigh, and all muscles of lower leg and foot (splits into tibial and common perineal)

Question 6

what is piriformis syndrome

Answer 6

where the piriformis muscle compress the sciatic nerve - get radicular pain, numbness and buttock tenderness

Question 7

femoral shaft fracture damages which nerve / artery

Answer 7

femoral

Question 8

what happens to the proximal segment in a femoral shaft fracture

Answer 8

gets pulled into external rotation by gluteus medius and minimus and then flexion by iliopsoas

Question 9

complications of femoral shaft fracture

Answer 9

fat embolism, non union

Question 10

how would a fat embolism present

Answer 10

resp signs (tachycardia, tachypnoea and hypoxia) and petechial rash and confusion

Question 11

how do you Tx fat embolism

Answer 11

supportive care but do prompt fixation to prevent it occurring

Question 12

surgery for a femoral shaft fracture

Answer 12

IM nail

Question 13

most common open fracture is

Answer 13

phalanx

Question 14

Ix for tibial shaft fracture

Answer 14

full length AP and lateral Xray

Question 15

MX of tibial shaft fracture

Answer 15

reduction and above knee backslab
IM nail

Question 16

when might you have to do ORIF and plates in a tibial shaft fracture

Answer 16

if it is particularly proximal or distal

Question 17

what causes a tibial plateau fracture (normally lateral)

Answer 17

high energy (jumping)

Question 18

with any fracture what is is essential to assess for and SAY IN EXAM

Answer 18

assess for neurovascular problems

Question 19

high risk of what in a tibial shaft fracture

Answer 19

compartment syndrome

Question 20

if there is an associated fibula fracture with a tibia shaft fracture, what does the level of the fracture indicate

Answer 20

high energy will be at the same level and low energy will be at a different level

Question 21

why would a tibial plateau fracture lead to rapid degenerative changes

Answer 21

as there is disruption of the articular surface

Question 22

main complication of tibial plateau fracture

Answer 22

OA

Question 23

in what direction does the hip normally dislocate

Answer 23

posterior

Question 24

how is the hip held in a dislocation

Answer 24

adducted, internally rotated and shortened

Question 25

timeframe to reduce the hip when it is dislocated in order to prevent avascular necrosis s

Answer 25

4 hours

Question 26

what is a hip dislocation normally associated with and why

Answer 26

high energy force so normally has fractures too

Question 27

pain in trochanteric bursitis exacerbated by what (pain typically over GT and will radiate down thigh)

Answer 27

external rotation

Question 28

how to treat trochanteric bursitis

Answer 28

should resolve, advise avoid excessive adduction (crossing legs) and do some gluteal strengthening

Question 29

most common site for a metatarsal stress fracture

Answer 29

2nd