Session 9

Question 1

What factors can influence bone healing?

Answer 1

Local - injury (fracture configuration, soft tissue injury), bone (cancellous vs cortical), treatment (reduction, infection)
Regional - blood supply, muscle cover
Systemic - age, bone pathology

Question 2

What are examples of early fracture complications?

Answer 2

Local - nerve injury, vascular injury, compartment syndrome, avascular necrosis, infection

Systemic - hypovolaemia/shock, fat embolism (from bone marrow)

Question 3

What are examples of late fracture complications?

Answer 3

Local - delayed Union, non Union, malunion, myositis ossification, refracture

Systemic - osteoporosis, joint stiffness, osteoarthritis

Question 4

Where do stress fractures commonly occur?

Answer 4

Spine, tibia, femur, pelvis, foot. Women more likely.

Question 5

What are the different classifications of fracture by type?

Answer 5

Greenstick (in children, one side broken the other bent), transverse, oblique, spiral, comminuted (many parts), compression.

Question 6

What are the different classifications of fractures according to their location?

Answer 6

Diaphyseal, metaphyseal, epiphyseal, condylar, articular, avulsion, fracture-dislocation

Question 7

What is a pathological fracture?

Answer 7

A fracture occurring through abnormal bone under physiological load

Question 8

What are the muscles of the anterior, lateral and posterior compartments of the leg?

Answer 8

Anterior - tibialis anterior, extensor digitorum longus, extensor hallucis longus and fibularis tertius
Lateral - peroneus longus and brevis
Posterior - gastrocnemius, soleus and plantaris (superficial). Popliteus, flexor hallucis longus, flexor digitorum longus and tibialis posterior (deep).

Question 9

How is the power of the tibialis anterior tested?

Answer 9

Standing on heels

Question 10

What is foot drop and what does it result from?

Answer 10

Common fibular nerve is damaged. Anterior muscles of leg are paralysed leading unopposed plantar flexion of the foot. The patient performs an “eversion flick” when walking.

Question 11

How is the common fibular nerve located during dissection?

Answer 11

It passes through the two heads of the Peroneal longus before bifurcating.

Question 12

What does a calcaneal reflex test?

Answer 12

Spinal roots S1-S2

Question 13

What are the bursae associated with the calcaneal tendon?

Answer 13

Subcutaneous calcaneal bursa between skin and calcaneal tendon.
Deep bursa of calcaneal tendon between the tendon and the calcaneus.

Question 14

How does a ruptured calcaneal tendon commonly occur and how is it treated?

Answer 14

In patients with a history of calcaneal tendinitis during forceful plantar flexion. Treatment usually non surgical except in active lifestyles.

Question 15

What are “shin splints”?

Answer 15

Oedema and pain in distal two thirds of the tibia due to repetive microtrauma of tibialis anterior.

Question 16

Describe the anatomical course of the popliteal artery

Answer 16

Descends down the posterior thigh, giving off the genicular branches that supply the knee joint. It moves through the popliteal fossa and exits sandwiched between the gastrocnemius and popliteus muscles. It terminates at the lower border of the popliteus by bifurcating into anterior and posterior tibial arteries.

Question 17

Describe the anatomical course of the posterior tibial artery

Answer 17

Travels distally along the surface of the deep muscles, giving off the fibular artery which travels to the lateral compartment. It accompanies the tibia nerve travelling into the foot via the tarsal tunnel.

Question 18

Describe the anatomical course of the anterior tibial artery

Answer 18

Passes anteriorly through a gap in the interosseous membrane. It moves distally down the leg to the foot where it becomes the dorsalis pedis artery.

Question 19

Describe the arterial supply to the foot

Answer 19

Dorsalis pedis artery - passes over the dorsal aspect of the tarsal bones before moving inferiorly towards the sole of the foot. It then anastomoses with the lateral plantar artery to form the deep plantar arch (supplies toes). It supplies the tarsal bones and the dorsal aspect of the metatarsals and contributes to the supply of the toes.
Posterior tibial artery - splits into the lateral and medial plantar arteries as it enters the foot. These supply the plantar side of the foot and contributes to the supply of the toes.

Question 20

Where are the main pulse points of the lower limb?

Answer 20

Femoral pulse - in femoral triangle midway between ASIS and pubis
Popliteal - difficult, ask patient to slightly flex their knee, relaxing the fascia around the popliteal fossa
Posterior tibial - behind medial malleolus, relax flexor retinaculum by inverting foot
Dorsalis pedis - dorsum of foot just lateral to hallucis longus tendon