Pelvis Flashcards
Which muscle originates on ASIS?
What can be trapped under ASIS? What’s this called?
Sartorius
LFCN can be trapped (meraglia paresthetica)
Which muscle originates on AIIS?
Rectus femoris
Major muscle that originates on Ischial tuberosity
Hamstrings
Structures that exit greater sciatic foramen?
POPS IQ Pudendal nerve nerve to Obturator internus Posterior cutaneous nerve of thigh Sciatic nerve Inferior gluteal artery nerve to Quadratus femoris
How are acetabular zones defined?
2 lines: ASIS to center of acetabulum and its perpendicular.
Dangers of acetabular zones?
No screw in anterior zones (anterior superior has external iliac artery/vein, anterior inferior has obturator nerve, artery, and vein.
Posterior superior is safe zone, watch for sciatic nerve, superior gluteal n,a,v
Posterior inferior is secondary safe zone. Watch for sciatic nerve, inferior gluteal n,a,v, and internal pudendal n,a,v
Denis classification?
Vertical sacral fractures. Zones of sacrum. Zone 1 is lateral to foramina, zone 2 is through foramina, zone 3 is medial to foramina. Zone 3 is worst, look for nerve root injury and CES.
Young and Burgess classification?
Pelvic ring fx:
Anterior posterior (AP)
I) 2.5cm diastasis + anterior SI injury but vertically stable.
III) Complete anterior and posterior disruption, unstable
Lateral compression (LC)
I) Sacral compression + ipsilateral rami fracture
II) LC1 + iliac wing fx or posterior SIOJ injury, Vertically stable.
III) LC 2 with contralateral APC3 (windswept pelvis)
Bleeding in pelvic fx
Venous>arterial (internal pudendal a > superior gluteal a)
Letournel & Judet classification
Acetabular fx:
Elementary: posterior wall/column, anterior wall/column, transverse
Associated: post. column and post wall, transverse and post wall, T type, ant. column and post hemi transverse both columns.
Strongest ligament in pelvis?
Posterior SI ligament, vertical stability
Which ligament divides sciatic foramen?
Sacrospinous
Sensory distribution of iliohypogastric?
Suprapubic, lateral butt/thigh
Sensory of ilioinguinal
Inguinal region
Sensory of genitofemoral nerve
Scrotum/mons
LFCN
Lateral hip/thigh
Pudendal nerve sensory distribution?
Perineum
Significance of Trendelenberg sign/gait?
Contralateral abductor/gluteus medius dysfunction (superior gluteal n)
Pelvic rock?
Push both iliac crests, motion indicates injury
SI stress test
Press ASIS and iliac crests, pain could indicate SI ligament injury
Patrick test
AKA FABER,
flex, abduct, externally rotate hip. SI pathologuy
Meralgia
Press medial to ASIS, LFCN entrapment if pain
What runs underneath the quadratus femoris?
Ascending branch of the medial circumflex artery
What pierces psoas and lies on anterior surface of psoas muscle?
genitofemoral n.
What will retractor placed behind the transverse acetabular ligament injure?
Obturator nerve (L2-4)
Which nerve lies between psoas major and iliacus?
Femoral nerve (L2-4)
What plexus lies on piriformus m?
Lumbosacral plexus
Path of pudendal n in pelvis?
Exits greater sciatic foramen and enters through lesser sciatic foramen
When does External Iliac Artery change name?
Changes to Femoral artery after the inguinal ligament
Branches of Femoral artery
Superficial circumflex iliac Superficial epigastric Superficial and deep external pudendal Profunda femoris, which gives off: medial circumflex femoral lateral circumflex femoral
Ilioinguinal approach to hip
Windows (3)
Dangers?
Window 1: lateral to iliopsoas and femoral nerve
Window 2: Between iliopsoas/femoral nerve and external iliac artery, lateral superior pubic ramus
Window 3: Medial to external iliac artery and spermatic cord
Dangers: Ext iliac vessels, corona mortis, femoral nerve, LFCN, inferior epigastric artery, spermatic cord, bladder
Kocher-Langenbeck approach
What is split?
Dangers?
Posterior approach to hip
Gluteus maximus fascia is split in line with fibers, inferior gluteal nerve is limit to the split. Tensor fasciae latae is also split.
Dangers: Sciatic nerve, inferior gluteal artery, superior gluteal vessels and nerve. Do NOT take down quadratus femoris due to vascular risk.
