Lower limb viva prep Flashcards
What are the parts of the hip bone?
The ilium
The ischium
The pubis
What are the three articulations of the hip bone?
Sacroiliac joint - articulation with the sacrum
Pubic symphysis - articulation with corresponding hip bone
Hip joint - articulation with head of femur
What joins the three parts of the hip bone prior to puberty?
At what age do they begin and complete to fuse?
The triradiate cartilage
Begin to fuse at age 15-17
Completed at age 20-25
What are the bony landmarks of the ilium?
Anteriorly: iliac fossa on the wing of ilium (concave)
Iliac crest
ASIS (anterior superior iliac spine)
Anterior inferior iliac spine
Acetabulum
Posteriorly: gluteal surface of the wing of ilium (convex)
Posterior superior iliac spine
Which muscles attach to the ilium?
Gluteal muscles - attach to external surface of the ilium at the anterior, posterior and inferior gluteal lines
Iliacus muscle - attaches medically at iliac fossa
What is the clinical relevance of the ASIS?
Measure the true leg length from ASIS to medial malleolus
Discrepancy seen in hip disorders
How do you measure the true leg length?
From ASIS to medial malleolus
Discrepancy seen in various hip disorders
How do you measure the apparent leg length?
From the umbilicus to the medial malleolus
Where does the inguinal ligament attach?
From ASIS to pubic tubercle
What are the parts of the pubis?
Body (articulates at pubic symphysis) Superior rami (part of acetabulum) Inferior rami (part of ischiopubic ramus)
Two rami form part of the border of obturator foramen
What are the borders of the obturator foramen?
Inferior- ischiopubic rami (inferior ischial and pubic rami), part of body of ischium
Superior - superior ramus of pubis
Laterally - part of body of ischium, superior ischial ramus
Medial - body of pubis
What are the contents of the obturator foramen?
Obturator nerve
Obturator artery
Obturator vein
What are the parts of the ischium?
Body of the ischium Superior and inferior ischial rami Ischial spine Posteriorly: Greater sciatic notch Ischial tuberosity
What ligaments attach to the ischium?
Sacrospinous ligament: ischial spine to sacrum
Form greater sciatic notch - neurovasculature of lower limb incl sciatic nerve & piriformis muscle
Sacrotuberous ligament: ischial tuberosity -> sacrum forming lesser sciatic notch
How do fractures occur in the pelvic bone?
Direct trauma (vehicular accident) Forces transmitted form the lower limb (heavy fall on the feet)
Where do fractures occur on the pelvic bone?
Pubic rami
Acetabulum
Sacroiliac joint
Borders of the femoral triangle
Superior border - inguinal ligament
Lateral border - medial border of sartorial
Medial border - medial border of adductor longus
(Pelvic floor - rest of adductor longus)
Roof - fascia lata
Base - pectineous, iliopsas, adductor longus muscles
What is the function of the inguinal ligament at the femoral triangle?
Acts as a flexor retinaculum supporting the femoral triangle during Flexion At the hip
Contents of the femoral triangle
Femoral nerve
Femoral artery
Femoral vein
Femoral canal- lymph nodes and vessels
What is contained by the femoral sheath?
Femoral artery,vein and canal in a facial compartment aka the femoral sheath
Why is there empty space in the femoral triangle?
To allow veins and lymph vessels to distend when coping with different levels of flow
Where can you palmate the femoral pulse?
Inferior to where femoral artery crosses inguinal ligament
Midway between pubic symphysis and ASIS
Presence of femoral pulse = blood reaching lower extremity
Describe the procedure of a coronary angiography
Superficial femoral artery in femoral triangle is catheterised with long thin tube
Navigated up external iliac artery, common iliac artery, aorta and into coronary vessels
Radioactive dye ejected into coronary vessels
Wall thickening or blockage can be visualised via xray
How do you check arterial blood gasses ?
Catherine the femoral artery
Define a hernia
Condition in which internal part of an organ is displaced and protrudes through a weakness in the muscle or the wall of the cavity containing it
Describe a femoral hernia
Part of bowel pushes into femoral canal Protrudes through femoral ring Underneath inguinal ligament Manifests as clinical lump/bulge in area of femoral triangle Lump interolaterally to pubic tubercle
Requires surgical intervention to treat
More common in woman due to wider bony pelvis
Tough walls of femoral canal can result in a strangulated hernia
Where is the femoral canal located?
It is an anatomical compartment
In anterior thigh
Smallest most medial part of femoral sheath
Approx 1.3 cm long
Contents of femoral canal
Lymphatic vessels - draining deep inguinal lymph nodes
Deep lymph node - the lacunar node
Empty space - allows distension of adjacent femoral vein
Loos connective tissue
What is a strangulated hernia?
Hernia with compromised blood supply
Shape, location and function of popliteal fossa
Diamond shaped
Posterior side of knee
Path for structures to move from thigh to leg
Borders of popliteal fossa
Superiomedial border - semimembranosus
Superiolateral border - biceps femoris
Inferiomedial border - medial head of gastrocnemius
Inferiolateral border - lateral head of gastrocnemius and plantaris
Floor - posterior surface of knee joint capsule, post surface of femur
Roof - 2 layers: popliteal fascia (continuous with fascia lata of leg) and skin
Contents of popliteal fossa
Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve
What does the sciatic nerve split into, in the popliteal fossa?
Tibial nerve
Common fibular nerve
What tendon does the fibular nerve follow?
Biceps femoris tendon
What pierces the fascia of the popliteal fossa?
Small saphaneous vein
To empty into popliteal vein
Describe a baker’s cyst
Inflammation and swelling of the semimembranosus bursa (fluid filled sac in the knee joint)
Arises with arthritis of knee (rheumatoid or osteo)
Usually selfresolves - the cyst can rupture and produce symptoms similar to DVT
What is the deepest structure in the popliteal fossa?
Popliteal artery
What is the most superficial contents of the popliteal fossa?
Tibial and common fibular nerves
What is an aneurysm?
Dilation of an artery greater than 50% of normal diameter
Consequences of an aneurysm in the popliteal artery?
Popliteal fascial roof is tough and non extensible
Compression of tibial nerve - leg anaesthesia/ loss of leg motor function
Aneurysm can be palpated by obvious pulsation in fossa with abnormal arterial sounds
What are the borders of the femoral canal?
Medial border - lacunar ligament
Lateral border - femoral vein
Anterior border - inguinal ligament
Posterior border - pectineal ligament and superior rami of pubis
Superior border - femoral ring, closed by CT layer (femoral septum) pierced by lymphatic vessels exiting in the canal
