Pelvis

Question 1

Which muscle originates on ASIS? What can be trapped under ASIS? What’s this called?

Answer 1

Sartorius LFCN can be trapped (meraglia paresthetica)

Question 2

Which muscle originates on AIIS?

Answer 2

Rectus femoris

Question 3

Major muscle that originates on Ischial tuberosity

Answer 3

Hamstrings

Question 4

Structures that exit greater sciatic foramen?

Answer 4

POPS IQ

Pudendal nerve

nerve to Obturator internus

Posterior cutaneous nerve of thigh

Sciatic nerve

Inferior gluteal artery

nerve to Quadratus femoris

Question 5

How are acetabular zones defined?

Answer 5

2 lines: ASIS to center of acetabulum and its perpendicular.

Question 6

Dangers of acetabular zones?

Answer 6

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

Question 7

Vertical sacral fractures classifications?

Answer 7

Denis classification

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.

Question 8

Pelvic ring fx classification

Answer 8

Young and Burgess classification

Anterior posterior (AP)

I) 2.5cm diastasis + anterior SI injury but vertically stable.

II) Widened anterior SI joint + disrupted anterior SI

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)

Question 9

Bleeding in pelvic fx

Answer 9

Venous>arterial (internal pudendal a > superior gluteal a)

Question 10

Acetabular fx classification?

Answer 10

Judet and Letournel classification

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.

Question 11

Strongest ligament in pelvis?

Answer 11

Posterior SI ligament, vertical stability

Question 12

Which ligament divides sciatic foramen?

Answer 12

Sacrospinous

Question 13

Sensory distribution of iliohypogastric?

Answer 13

Suprapubic, lateral butt/thigh

Question 14

Sensory of ilioinguinal

Answer 14

Inguinal region

Question 15

Sensory of genitofemoral nerve

Answer 15

Scrotum/mons

Question 16

LFCN senory distribution

Answer 16

Lateral hip/thigh

Question 17

Pudendal nerve sensory distribution?

Answer 17

Perineum

Question 18

Significance of Trendelenberg sign/gait?

Answer 18

Contralateral abductor/gluteus medius dysfunction (superior gluteal n)

Question 19

Pelvic rock?

Answer 19

Push both iliac crests, motion indicates injury

Question 20

SI stress test

Answer 20

Press ASIS and iliac crests, pain could indicate SI ligament injury

Question 21

Patrick test AKA FABER

Answer 21

flex, abduct, externally rotate hip. SI pathologuy

Question 22

Meralgia

Answer 22

Press medial to ASIS, LFCN entrapment if pain

Question 23

What runs underneath the quadratus femoris?

Answer 23

Ascending branch of the medial circumflex artery

Question 24

What pierces psoas and lies on anterior surface of psoas muscle?

Answer 24

genitofemoral n.

Question 25

What will retractor placed behind the transverse acetabular ligament injure?

Answer 25

Obturator nerve (L2-4)

Question 26

Which nerve lies between psoas major and iliacus?

Answer 26

Femoral nerve (L2-4)

Question 27

What plexus lies on piriformus m?

Answer 27

Lumbosacral plexus

Question 28

Path of pudendal n in pelvis?

Answer 28

Exits greater sciatic foramen and enters through lesser sciatic foramen

Question 29

When does External Iliac Artery change name?

Answer 29

Changes to Femoral artery after the inguinal ligament

Question 30

Branches of Femoral artery

Answer 30

Superficial circumflex iliac Superficial epigastric Superficial and deep external pudendal Profunda femoris, which gives off: medial circumflex femoral lateral circumflex femoral

Question 31

Ilioinguinal approach to hip Windows (3) Dangers?

Answer 31

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

Question 32

Kocher-Langenbeck approach What is split? Dangers?

Answer 32

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.