Radiology Lower Limb Flashcards
1
Q
3 types of fractured hips?
A
- Intertrochanteric fracture: greater to lesser trochanter
- Femoral neck: below head of femur
- Subtrochanteric Fracture: below lesser trochanter, entire bone must be stabilized
-most fractured hips are externally rotated, muscles pull on broken bones, shorten and rotate leg
2
Q
Blood supply to femoral head? Danger of fracturing it?
A
- Medial Circumflex Femoral Artery comes off Deep Femoral and gives most blood supply to femoral head and neck
- could cause death to head, or inability to fully heal
3
Q
How to test for Gluteus Medius and joint stability?
A
- stand on one leg, if there is a problem the hip will drop down (Trendelenberg Sign)
- if the person is old, it might be because the articular cartilage is worn down
- can happen if Superior Gluteal Nerve is damaged during surgery
4
Q
Last bone to ossify? Clinical significance?
A
- iliac crest
- get X-ray of hand and pelvis to determine how much more growth a child has, wait to treat scoliosis
5
Q
Why do women generally have genu valgus?
A
- women have wider pelvis
- femur is more angled to compensate
- affects knees over time
6
Q
Hallux Valgus?
A
- lateral deviation of big toe
- medial deviation of 1st metatarsal
- adductor muscles pull
- develop exostoses (cartilage) or bunion on medial side of metatarsal head
- also called metatarsus primus varus
- surgery to correct: release adductors, take off exostoses, and realign bone
- may require arthroplasty: surgical reconstruction of proximal MP joint
7
Q
Spina bifida in infants and risk of hip dislocation? How to fix it?
A
- posterior vertebrae don’t close during development, spinal cord is exposed
- nerves don’t work properly and femoral head dislocates
- Surgery to cut hole in pelvis and take Psoas Major and attach it to Greater Trochanter to prevent dislocation
- it becomes an abductor muscle instead of flexor
8
Q
Order of vessels from lateral to medial that go under inguinal ligament?
A
- femoral nerve
- artery
- vein
- lymphatic
9
Q
Risk of clot in femoral vein?
A
- Pulmonary Embolism
- anticoagulants to help
- put cage in there to prevent clot from reaching heart
10
Q
Largest sesamoid bone in body? Function?
A
- Patella
- used as fulcrum in leg to help the quads do their job of extending the knee
11
Q
How do you check to see if a baby hip is dislocated?
A
- femoral head not yet ossified so X-ray doesnt help
- Barlow Test to check for dislocation
- abduct too much and medial circumflex will be kinked and lead to necrosis of femoral head
12
Q
Innervation of Pes Anserinus?
A
- Sartorius: Femoral
- Gracilis: Obturator
- Semitendinosus: Tibial division of Sciatic
-they function to internally rotate knee
13
Q
ACL surgery?
A
- take Semitendinosus and Gracilis, cut the long tendon and fuse these muscles together
- use tendon as new ACL, drill holes in femur to feed it through
- bone fibers need to fuse into new tendon, could take one year
14
Q
Osteochondritis desicans?
A
bone under cartilage dies due to lack of blood flow
15
Q
Which direction does the patella want to dislocate?
A
- laterally
- valgus stance increases chance of patella moving laterally
- strengthen Vastus Medialis to pull patella more medially
16
Q
What imaging technique shows meniscal or ACL tears?
A
MRI
17
Q
How to test an achilles tendon tear?
A
- lie on stomach
- flex knee and squeeze gastrocnemius and soleus
- if the foot moves, the tendon is not torn
- if pain, could be plantaris tear
18
Q
Outcome of Tibial fracture?
A
- hard to heal because superficial to skin, may lose leg
- supports most body weight (Fibula is not weight bearing- can remove bone for graft)
- if patient is smoker it may never heal
- need long leg cast to immobilize knee and foot joints
- if cannot fix with cast, put rod through medullary canal
19
Q
Mangled extremity index?
A
- based on bone, muscle, skin lost and amount of contamination in wound
- used to see if you can save leg or need to amputate
20
Q
What supports the lateral knee?
A
- Biceps Femoris
- LCL
21
Q
Attachments of MCL?
A
adductor tubercle and goes deep to Pes Anserinus
22
Q
Function of Sartorius?
A
Sartorial Slender:
- flex hip
- externally rotate
- abduct
23
Q
Ankle Mortise?
A
- Medial Malleolus of Tibia and Lateral Malleolus of Fibula designed to keep Talus in place
- allows ankle to dorsi and plantar flex
- must be carefully fixed if fractured, lateral malleolus is more important
- AP xray to see relationship
- Fibula sits more posterior to Tibia, to really see relationship, need to internally rotate ankle to bring Fibula and malleoli into view
24
Q
What goes under sustentaculum tali of calcaneus?
A
Flexor Hallucis Longus
-holds talus up
25
Fall from height, what's fractured?
- Calcaneus fractured
- evaluate for compression fracture in thoracolumbar spine because they roll forward into flexion when they fall and compress vertebral bodies (lateral xray)
26
Role of Navicular bone? What supports it
- top of arch, supports arch
| - Posterior Tibialis Tendon and Fibularis Longus
27
Jones Fracture
- Fibularis Brevis attaches to 5th metatarsal
| - during ankle roll, can break tuberosity off
28
March Fracture?
- crack in 2nd or 3rd metatarsal
| - stress fracture from jogging or marching
29
Function of Quadratus Plantae?
- Flexor Digitorum Longus comes around medial malleolus and attaches to toes at an angle
- Quadratus plantae attaches to the tendons at an oblique angle to pull the digitorum straight
30
Sesamoid bones in foot?
- medial and lateral, or fibular and tibial
- form under metatarsal head of big toe in the tendon of Flexor Hallucis Brevis
- Flexor Hallucis Longus tendon runs through these bones
31
Lisfranc Fracture?
- injury at base of metatarsals where cuboid and cuneiforms are
- difficult to diagnose because hard to get a lateral view
32
How to see if problem with arch on xray?
must be weight bearing xray
33
Pes planus?
- flat arch
- most are born with it, some athletes have it
- can be pathological due to tearing of Tibialis Posterior or ligaments in foot
- can be due to abnormal or fusion of tarsals
- problem because you walk and put weight on inside of arch, pronating foot on navicular bone, will stretch ligament over time
34
Plantar Fasciitis?
- help support arch
- need good arch support if on feet a lot
- can cause bone spur off calcaneus
- due to inflammation of fascia
35
Foot deformities in babies?
- Congenital club foot (Talipes Equinovarus)
- Talus becomes vertical and toes go against Tibia
- may need to cut ligaments and put them in place, put in a cast and change it every week
36
Compartment Syndrome?
- pressure within crural fascia compartments is high
- bleeding and swelling will squeeze muscles
- blood cannot leave, waste products remain, low O2
- could be from severe crush injury or Tibial injury
- could become necrotic and lose leg
- need to release pressure with surgery, muscle squeezes through incisions
- cover with skin grafts
