Lower limb Flashcards
(139 cards)
1
Q
Borders of the femoral triangle
A
superior - inguinal ligament
lateral - medial border of sartorius
medial - medial border of adductor longus
floor - pectineus, iliopsoas and adductor longus
root - fascia lata
2
Q
Content of femoral triangle
A
Femoral nerve
Femoral artery
Femoral vein
Femoral lymph nodes/canal
3
Q
What is the femoral sheath?
A
Continuation of the fascia lining the abdomen
Anterior wall - continuous with fascia transversalis
Posterior wall - continous with fascia iliaca.
Sheath surrounds the femoral vessels and lymphatics for about 2.5cm below the inguinal ligament.
4
Q
Content of femoral sheath
A
Femoral artery, vein and canal
5
Q
Borders of Femoral canal (femoral ring)
A
Small medial compartment of the femoral sheath.
At the superior aspect is called the femoral ring:
Roof - inguinal ligament
lateral - femoral vein
medial - lacunar ligament
floor - pectineal ligament
6
Q
Content of femoral canal
A
lymph nodes (femoral hernia)
7
Q
How does a femoral hernia present?
A
Femoral hernia get hernial sac passing down femoral canal pushing septum (forms opening of femoral ring) before it
When passes out of bottom end of femoral canal forms a swelling in upper part of thigh deep to fascia
Swelling will lie below and lateral to pubic tubercle
8
Q
Borders of adductor canal/hunter’s canal
A
Runs from apex of femoral artery to opening in adductor magnus.
Floor - adductor longus and magnus
Lateral - vastus medialis extends from the apex of femoral triangle to adductor hiatus
Sup: from apex Fem triangle
Inferiorly - adductor hiatus in adductor magnus
9
Q
Content of adductor canal / hunter’s canal
A
Femoral artery
Femoral vein
Saphenous nerve
Terminal part of obturator nerve
10
Q
Borders of Popliteal fossa
A
Inferior - 2 heads of gastrocnemius and plantaris
Lateral - biceps femoris
Medial - semimembranosus floor - posterior joint capsule
Roof - popliteal fascia
11
Q
Content of popliteal fossa
A
popliteal artery
popliteal vein
tibial nerve
common peroneal nerve
Popliteal lymph nodes
12
Q
What is the relationship of structures at the popliteal fossa?
A
Tibial and common fibular nerves (follows biceps femoris tendon) - superficial
Small saphenous vein
Deepest structure is the popliteal artery
13
Q
Hip joint
A
Ball and socket joint, articular cartilage
Acetabulum (pubis, ischium, ilium) and femoral head
3 ligaments:
- *Pubofemoral** (superior pubic rami to intertrochanteric line)
- *Ischiofemoral** (ischium to greater trochanter) - weaker point
- *Iliofemoral** (AIIS to intertrochanteric line) - strongest point ligament of head of femur (contains a branch of obturator artery)
medial circumflex femoral artery (branch of profunda femoris) supplies the femoral head
14
Q
What does the sacrotuberous ligament connect?
A
Connects the back of the sacrum to the ischial tuberosity
15
Q
What does the sacrospinous ligament connect?
A
Connects back of sacrum to spine of ischium
16
Q
Hip muscles - superficial abductors and extensors
A
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor Fascia Lata
17
Q
Gluteus maximus
A
origin - posterior surface of Ilium, sacrum, coccyx
insertion - Gluteal tuberosity of the femur, fascia lata
innervation - inferior gluteal nerve action
18
Q
Gluteus medius
A
origin - iliac crest
insertion - lateral surface greater trochanter of femur
innervation - superior gluteal nerve
action - abductor, internal rotation
19
Q
gluteus minimus
A
Origin- ilium
insertion - anterior greater trochanter of femur
innervation - superior gluteal nerve action - abductor hip, internal rotation
20
Q
Tensor fascia lata
A
origin - anterior iliac crest, ASIS
insertion - iliotibial band ( which extends to popliteal fascia, lateral condyle of tibia)
innervation - femoral nerve
action - abductor and internal rotation
Role in tensing FASCIA LATA
21
Q
Attachment of fascia lata
A
Posterior - sacrum and coccyx
Lateral - iliac crest
Anterior - inguinal ligament, superior pubic rami
Medial - Ischiopubic rami, ischial tuberosity , sacrotuberous ligament
Distally - lateral tibial condyle
22
Q
What is the role of the fascia lata in the leg?
A
Gives rise to three intermuscular septa that attach centrally to the femur.
The septa divide the thigh musculature into three compartments;
anterior
medial
lateral
The lateral intermuscular septum is the strongest of the three due to reinforcement from the iliotibial tract
23
Q
Hip muscles - deep lateral rotators
A
Piriformis
Gemelli
Obturator internus
Quadratus femoris
24
Q
Piriformis
A
origin - anterior surface of sacrum
insertion - greater trochanter of femur
innervation - nerve to piriformis
action - lateral rotation, abduction passes through the GREATER sciatic foramen
25
Gemellus superior and inferior
**origin** - ischial spine and inferior from ischial tuberosity
**insertion** - greater trochanter of femur
**innervation** - nerve to obturator internus and quadratus femoris
**action** - lateral rotation
26
Obturator internus
**origin** - Internal surface of obturator membrane and posterior bony margins of obturator foramen
**insertion** - greater trochanter of femur
**innervation** - nerve to obturator internus
**action**- lateral rotation passes through the LESSER sciatic foramen
27
Quadratus femoris
**origin** - Ischial tuberosity
**insertion** - quadrate tuberosity on the intertronchanteric line
**innervation** - nerve to quadratus femoris
**action** - lateral rotation
28
Contents of greater sciatic foramen
(Suprapiriform and infrapiriform)
**Supra Piriform foramen**
Superior gluteal artery, vein and nerve
**Piriformis**
* *Infrapiriform foramen**
* *P** osterior cutaneous nerve of thigh
* *I** nferior gluteal artery and nerve
* *N** erve to quadratus femoris
* *P** udenal nerve
* *I** internal pudenal artery and vein
* *N** erve to obturator internus
* *S** ciatic nerve
29
Content of lesser sciatic foramen
**P**udendal nerve
**I**nternal pudendal vessels
**N**erve of obturator internus
**T**endon **O**bturator internus
30
Greater sciatic foramen
**Anterolaterally** - greater sciatic notch of ilium
**Posteromedially** - sacrotuberous ligament
**Inferiorly** - Sacrospinous ligament
**Superiorly** - anteriror sacroiliac ligament
31
Lesser sciatic foramen
**Anterior** - tuberosity of ischium
**Superior** - sacrospinous ligament
**Posterior** - sacrotuberous ligament
32
Anterior compartment of thigh
33
Iliacus
**origin** - anterior surface of Ilium
**insertion** - lesser tubercle of femur
**innervation** - femoral nerve
**action** - flexor
34
Psoas major
**origin** - Transverse process of L2-4
**insertion** - lesser tubercle of femur innervation - L1-L3
**action** - flexor
35
Vastus lateralis
**origin** - greater trochanter and lateral lip of linea aspera
**insertion** - patellar tendon
**innervation** - femoral nerve
**action** - knee extensor
36
Vastus intermedius
**origin** - anterior and lateral surface of femoral shaft
**insertion** - patellar tendon
**innervation** - femoral nerve
**action** - knee extensor
37
vastus medialis
**origin** - intertrochanteric line and medial lip of linea aspera
**insertion** - patellar tendon
**innervation** - femoral nerve
**action** - knee extensor
38
Rectus femoris
**origin** - Acetabulum and AIIS
**insertion** - patellar tendon
**innervation** - femoral nerve
**action** - hip flexor and knee extensor
39
Sartorius
**origin** - ASIS
**insertion** - Superior medial surface of tibia
**innervation** - femoral nerve
**action** - hip flexor, lateral rotation, knee flexor
40
Pectineus
**origin** - Pectineal line on the anterior surface of pelvis
**insertion** - pectineal line inferior to lesser trochanter
**innervation** - femoral nerve
**action** - adduction and hip flexion
41
Muscles in the medial compartment of the thigh
42
Adductor magnus
**origin** - inferior pubic rami & ischial tuberosity
**insertion** - linea aspera, adductor tubercle/medial supracondylar line of femur
**innervation** - obturator and tibial
**action** - adduction
43
Adductor longus
**origin** - pubis
**insertion** - linea aspera
**innervation** - obturator nerve
**action** - adduction, medial rotation
44
Adductor brevis
**origin** - pubis and inferior pubic rami
**insertion** - linea aspera
**innervation** - obturator
**action** - adduction
45
Obturator externus
**origin** - obturator membrane
**insertion** - greater trochanter
**innervation** - obturator
**action** - lateral rotation
46
Gracilis
**origin** - inferior rami and body of pubis
**insertion** - medial surface of tibia, between sartorius and semitendinosus
**innervation** - obturator
**action** - adduction, flexion of knee
47
Muscles of posterior compartment of thigh
Bicep femoris
Semimembranosus
Semitendinosus
48
Biceps femoris
**origin** - Ischial tuberosity (long head), short head = linea aspera
**insertion** - Head of fibula
**innervation** - short head : common fibular nn, long head: tibial portion sciatic nn
**action** - flexion of knee
49
Semimembranosus
**origin** - ischial tuberosity
**insertion** - medial tibial condyle
**innervation** - sciatic nerve/tibial
**action** - flexion of knee
50
Semitendinosus
**origin** - ischial tuberosity
**insertion** - medial surface of tibia
**innervation** - sciatic nerve/tibial
**action** - flexion of knee
51
Proximal Femur
**Head** - joint with acetabulum with ligament teres
**Neck** - common fracture line
**Greater trochante**r - gluteal, lateral rotators
**Lesser trochante**r - hip flexors intertrochanteric line = becomes pectineal line posterior to lesser trochanter
52
Shaft of femur
Linea aspera - attachment of adductor muscles
Gluteal tuberosity
Medial supracondylar line = adductor tubercle
53
Distal femur
Condyles - articular surface of knee joint
Epicondyles - attachment for ligaments and muscles
Intercondylar fossa - ACL (lateral), PCL (medial)
54
Knee joint
Hinge joint, synovial joint
Joint capsules Bursa = Infrapatella, Suprapatella, subpatella, semimembranosus bursa
Ligaments - medial collateral (semimembranosus lies underneath), lateral collateral, ACL/PCL, patellar
Meniscus - medial C shaped (attached to medial collateral), lateral circular
55
Anterior compartment of the lower leg
Tibialis anterior
Peroneus tertius
Extensor hallucis longus
Extensor digitorum longus
56
Tibialis anterior
**origin** - lateral surface of tibia
**insertion** - medial cuneiform and 1st base of MTP
**innervation** - deep peroneal
**action** - dorsiflexion, inversion
57
Peroneus longus
**origin** - medial surface of fibula
**insertion** - 1st MTP medial side
**innervation** - deep peroneal
**action** - dorsiflexion, eversion
58
Extensor hallucis longus
**origin** - fibula shaft
**insertion** - Distal phalanx of big toe
**innervation** - deep peroneal
**action** - dorsiflexion
59
Extensor digitorum longus
**origin** - lateral condyle of tibia and medial surface of fibula
**insertion** - distal phalanx
**innervation** - deep peroneal
**action** - dorsiflexion
60
Lateral compartment of lower leg
Peroneus longus
Peroneus brevis
61
Peroneus longus
**origin** - lateral surface of fibula and lateral tibial condyle
**insertion** - medial cuneiform and base of 1st MTP
**innervation** - superficial peroneal nerve
**action** - eversion, plantar flexion
62
Peroneus brevis
**origin** - shaft of fibula
**insertion** - tubercle of 5th MTP
**innervation** - superficial peroneal nn
**action** - everision
63
Posterior compartment of leg - Superficial
Plantaris
Soleus
Gastrocnemius
64
Plantaris
**origin** - lateral supracondylar line of femur
**insertion** - achilles tendon
**innervation** - tibial nerve
**action** - plantar flexion
65
Soleus
**origin** - soleal line of tibia and proximal fibula
**insertion** - achilles tendon
**innervation** - tibial nerve
**action** - plantar flexion
66
Gastrocnemius
**origin** - medial and lateral condyle of femur
**insertion** - achilles tendon
**innervation** - tibial nerve
**action** - plantar flexion, knee flexor
67
Posterior compartment of lower leg - Deep
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
Popliteus
68
Tibialis posterior
**origin** - Interosseous membrane
**insertion** - navicular and medial cuneiform
**innervation** - tibial nerve
**action** - plantar flexion, inversion
69
flexor digitorum longus
**origin** - medial surface of tibia
**insertion** - distal phalanx
**innervation** - tibial nerve
**action** - plantar flexion
70
flexor hallucis longus
**origin** - posteriro surface of fibula
**insertion** - distal phalanx of big toe
**innervation** - tibial nerve
**action** - plantar flexion
71
Popliteus
**origin** - Posterior surface of tibia
**insertion** - lateral condyle of femur, lateral meniscus
**innervation** - tibial nerve
**action** - laterally rotates knee for UNLOCKING
72
Patella
SESSAMOID BONE patellafemoral groove
patellofemoral articulation thus part of knee joint
Enhances the extension of knee by quadriceps
73
Tibia
Medial bone in lower leg
Weight bearing bone
Patella ligament attaches to TIBIAL TUBEROSITY
Posterior surface - SOLEAL LINE
74
Fibula
Lateral bone of lower leg attaches to the lateral condyle of tibia
Posterior, lateral surface lies the common peroneal nerve at the fibular neck
Forms the lateral malleolus
75
Tarsal bones
Talus
Calcaneus
Navicular
Cuboid
3 cuneiforms
76
Joints of talus bone
3 articulations
Ankle joint
subtalar joint - calcaneus
talonavicular joint Fracture can lead to AVN
77
Joints of Calcaneus
2 articulations
Subtalar joint
Calcaneocuboid joint
78
Pott's fracture dislocation
79
Segond fracture
avulsion fracture of the lateral tibial plateau with ACL injury
80
Osgood schlatter disease
chronic avulsion fracture of tibial tuberosity where the patella ligament inserts
81
Maisonneuve fracture
Spiral fracture of proximal fibula
Tilofibular syndesmosis/deltoid ligament disruption/medial malleolus fracture
82
Jones fracture
extra articular fractue of base of 5th MTP
83
Subtalar joint
plane synovial joint
Posterior talar articular surface and posterior calcaneal articular facet
Joint capsule 3 ligaments - posterior/medial/lateral talocalcaneal ligament
Interosseous talocalcaneal ligament
84
Muscles in the dorsum of the foot
Extensor hallucis brevis
Extensor digitorum brevis
85
Extensor hallucis brevis
**origin** - calcaneus and extensor retinaculum
**insertion** - proximal phalanx of big toe
**innervation** - deep peroneal nerve
**action** - extend great toe at MTP
86
Extensor digitorum brevis
**origin** - calcaneus and extensor retinaculum
**insertion** - long extensor tendons
**innervation** - deep peroneal nerve
**action** - extension at MTP, IPJ
87
Muscles of foot - plantar 1st layer
Abductor hallucis
FLexor Digitorum brevis
Abductor digiti minimi
88
Abductor hallucis
**origin** - calcaneus, flexor retinaculum and plantar aponeurosis
**insertion** - medial base of proximal phalanx
**innervation** - medial plantar nerve
**action** - abduct the big toe
89
Flexor digitorum brevis
origin - calcaneus, plantar aponeurosis insertion - middle phalanges of toes innervation - medial plantar nerve action - flex PIPJ
90
Abductor digiti minimi
**origin** - calcaneus, plantar aponeurosis
**insertion** - proximal phalanx of 5th digit
**innervation** - lateral plantar nerve
**action** - abduct 5th toe
91
Muscles of the foot 2nd layer
Quadratus plantae
Lumbricals
92
Quadratus plantae
**origin** - calcaneus
**insertion** - FDL tendons
**innervation** - lateral plantar nerve
**action** - assist FDL
93
Lumbricals
**origin** - tendons of FDL
**insertion** - extensor hood of lateral four digits
**innervation** - medial/lateral plantar nerve
**action** - flexes MTPJ extends IPJ
94
Muscle of the foot 3rd layer
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi brevis
95
Flexor hallucis brevis
**origin** - Cuboid and lateral cuneiforms
**insertion** - proximal phalanx of big toe
**innervation** - medial plantar nerve
**action** - flexes MTPJ
96
Adductor hallucis
**origin** - oblique head (2-4th MTP) and plantar ligaments of MTPJ
**insertion** - lateral base of proximal phalanx of big toe
**innervation** - lateral plantar nerve
**action** - adduct toe
97
Flexor digiti minimi brevis
**origin** - base of 5th MTP
**insertion** - base of proximal phalanx of 5th
**innervation** - lateral plantar nerve
**action** - flexion of 5th toe
98
Muscles of the foot 4th layer
Plantar and dorsal interossei
Only 3 plantar interossei, 4 dorsal interossei
**innervation** - lateral plantar nerve
**action** - Dorsal - ABDUCT, plantar - ADDUCT
99
Order of structures at medial malleolus
100
branches of internal iliac artery in lower limbs
**I L**ove **G**oing **P**laces **I**n **M**y **V**ery **O**wn **U**nderwear
I: iliolumbar artery
L: lateral sacral artery
G: gluteal (superior and inferior) arteries
P: (internal) pudendal artery
I: inferior vesical (vaginal in females) artery
M: middle rectal artery
V: vaginal artery (females only)
O: obturator artery
U: umbilical artery and uterine artery (females only)
The first three branches in the mnemonic (iliolumbar, lateral sacral and superior gluteal) are branches of the posterior division of the internal iliac artery, the remaining branches are of the anterior division.
101
Femoral artery
Arises after inguinal ligament
Enters femoral triangle and ends at opening in adductor magnus muscle.
Branches:
* *Profunda femoris** (which gives rise to medial and lateral circumflex femoral arteries)
* *Genicular artery** - supplies the knee joint
102
popliteal artery
arises after adductor hiatus
Branches at knee then:
```
anterior tibial artery (dorsalis pedis)
Tibioperoneal trunk (posterior tibial and peroneal)
```
103
Course of femoral vein?
Enters thigh by passing through opening in adductor magnus (continuation of the popliteal vein)
Lies lateral to artery then posterior to artery then medial
104
Veins in the legs - deep
Anterior tibial vein
Posterior tibial vein
popliteal vein -
femoral vein
105
Superficial vein of legs
Great saphenous vein - medial aspect of leg, anterior to medial malleolus (closely accompanied by **saphenous nerve**)
Small saphenous vein - lateral aspect of leg - posterior to lateral malleolus, joins the popliteal vein
106
Course of the posterior tibial artery
Begins at lower level of popliteus muscle and passes downwards deep to gastrocnemius and soleus
Lies on posterior surface of tibialis posterior (lies lateral to medial malleolus as above)
Terminal branches are medial and lateral plantar arteries
107
What is the course of the anterior tibial artery?
Arises at lower level of popliteus muscle
Passes forward into anterior compartment of leg through an opening in the upper part of the interosseous membrane (accompanied by **deep peroneal nerve**)
At ankle joint:
* *Medial:** Tendon of EHL
* *Lateral side:** Deep peroneal nerve & EDL
108
What is in the lumbar plexus & what nerves originate there?
Formed in the psoas muscle from the anterior rami of upper 4 lumbar nerves
**I (twice) get laid on friday**
All lateral other than genitofemoral (ant) and obturator (medial)
Iliohypogastric
Ilioinguinal
Genitofemoral nerve (anterior)
Lateral cutaneous nerve of thigh
Obturator nerve (medial)
Femoral nerve
109
What are the nerve root values of the lumbar plexus?
**I (twice) Get Laid On Fridays -** nerves
2 from 1, 2 from 2, 2 from 3
Iliohypogastric (L1)
Ilioinguinal (L1)
Genitofemoral (L1, L2)
Lateral cutaneous nerve of thigh (L2, L3)
Obturator (L2, 3, 4)
Femoral (L2 , 3, 4)
110
Iliohypogastric nerve
Origin: L1
Pierces internal and external oblique internal oblique
Innervates internal and transverse abdominal muscles.
111
Ilioinguinal nerve
Origin: L1
Perforates transversus abdominis then accompanies spermatic cord (males) or round ligament of the uterus (females) through the superficial inguinal ring.
Supplies:
**Male:** Skin of the root of the penis and adjacent part of the scrotum
**Female: Skin** covering mons pubis and labia majora
NS does NOT pass through the deep inguinal ring therefore only travels through part of the inuinal canal.
112
Obturator nerve
L2-L4
Supplies the medial compartment (adductor) of the thigh
Skin - medial thigh
Passes through the obturator foramen
113
Femoral nerve
L2-L4
Supplies the anterior compartment of the thigh (thigh muscles that flex the hip joint and extend the knee.)
Anterior aspect of thigh
Gives off saphenous nerve -\> supplies sensation to medial side of leg and foot.
114
Genitofemoral nerve
L1-L2
Cremasteric muscle
Skin over the anterior part of scrotum, labia majora
115
Lateral cutaneous nerve of the thigh
L2-L3
Enters thigh at end of inguinal ligament
Supplies skin at lateral aspect of thigh and knee
116
What is the sacral plexus formed from?
L4, 5 S1, 2, 3, 4
On anterior surface of piriformis muscle
* *superior gluteal nerve** L4/5 S1
* *Inferior gluteal** L5 S1/2
* *Posterior femoral cutaneous** S1/2/3
* *Pudendal** S2/3/4
* *Sciatic** L4, 5, S1, S2, S3
117
What is the route of the superior gluteal nerve?
L4, 5, S1
Passes superior to the piriformis via the greater sciatic foramen
Accompanied bu sup. gluteal vein and artery
118
What is the course of the inferior gluteal nerve?
L5, S1, S2
Leaves pelvis via greater sciatic foramen **inferior** to piriformis muscle
Motor function - **gluteus maximus**
119
What is the route of sciatic nerve
L5 - S3
2 components:
* *Fibular** (dorsal division L4 - S2)
* *Tibial** (ventral divisions L4 - S3)
Formed on anterior aspect of piriformis muscle
120
What muscles are innervated by the tibial componenet of the sciatic nerve?
Muscles in:
**Posterior compartment of thigh** (other than SH of Biceps femoris - innervated by fibular portion of sciatic nerve)
Hamstring component of **adductor magnus
Posterior compartment of leg
Muscles in sole of foot**
121
What muscles are innervated by fibular portion of sciatic nerve?
**Short head of biceps femoris
Anterior and lateral compartments of the leg & extensor digitorum brevis muscle**
122
Common peroneal nerve
L4-S3
Runs downward through the popliteal fossa closely following medial border of biceps femoris
Leaves fossa by superficially crossing lateral head of gastrocnemius muscle
Passes behind fibula winds around neck goes through deep peroneous longus and divides into:
**Superficial peroneal nerve
Deep peroneal nerve**
123
Where can the common peroneal nerve be damaged and what are the clinical finidings
Extremely vulnerable to injury as it winds around the neck of the fibula
At this site is exposed to direct trauma
124
Deep peroneal nerve
**L4/L5**
Arises from common peroneal nerve
Enters anterior compartment of the leg
Initially lies lateral to ant. tibial artery, than anterior than lateral
Supplies:
* *Sensory:** web of 1st and 2nd toe
* *Motor:** Anterior compartment of leg
125
Superficial peroneal nerve
L4-S1
Arises at the lateral neck of fibula
Descends between **peroneus longus and brevis**
**Muscular branches**: peroneus longus & brevis
**Cutaneous branches:**
Supply dorsal surface of all toes other than 1st web space
126
What is the origin / route of the posterior cutaneous nerve of the thigh?
S1, 2, 3
Leaves pelvis via greater sciatic foramen. Enters inferiorly to piriformis muscle
Runs down back thigh to knee
Innervates skin of perineum, posterior surface thigh and leg.
127
Origin of the pudenal nerve & root?
S2, 3, 4
Leaves via greater sciatic foramen and then loops around **sacrospinus ligament** to enter pelvis via lesser sciatic foramen
**Motor:** Innervates EUS, EAS, levator ani muscle
**Sensory:** Innervates penis, clitorus and nerves of skin
128
Sural nerve
from common peroneal and tibial nerve cutaneous branch for lateral malleolus
129
In compartment syndrome what is the order of symptoms?
**pain** w/ passive stretch
**paresthesia and hypoesthesia** (indicative of nerve ischemia in affected compartment)
**paralysis**
**peripheral pulses absent** (amputation is inevitable)
130
What is the classification of ankle fractures and what is it based on?
Weber's classification
It is based on the relation of the fracture to the syndismosis.
131
Describe the classification of ankle fractures & mechanism of injury?
Weber's:
**A: sub syndismosis**
Mechanism: SAD (supination and adduction)
**B: syndismotic**
Mechanism: SEX (supination and external rotation)
OR
PAB (pronation and abduction)
**C: supra syndismotic**
Mechanism: PEX (pronation external rotation)
132
What type of # is this?
Weber B
133
What type of # is this?
Weber A
134
What type of # is this?
Weber C
135
Describe the stability of the different ankle fractures?
Weber's A = Stable
Weber's B = Stable/Unstable dependent on whether the deltoid ligament (medial) is intact
Weber's C = Unstable
136
What is the sensory nerve supply of the leg?
137
What position of the leg would you expect in a fracture of the upper 1/3 of the femoral shaft?
Leg is shortened and externally rotated.
Proximal fragment is:
**Flexed** by iliopsoas
**Abducted** by **gluteus medius & minimus**
**Laterally rotated** by **gluteus maximus, piriformis, obturator internus, gemelli and uadrator femoris**
Distal fragment is:
**Adducted & laterally rotated** by **adductors**
Pulled proximally by uads and hamstring
138
What is the displacement seen in a fracture of the middle shaft of femur
**Distal fragment:**
Pulled **proximally** by **hamstrings & uadriceps**
**Rotated backwards** by pull of **GASTROCNEMIUS**
139
What is the displacement seen in distal 1/3 femur fractures
Similar to Middle third of shaft fracture:
**Distal fragment:**
Pulled **proximally** by **hamstrings & uadriceps**
Rotated backwards by pull of **GASTROCNEMIUS**
NB distal fragment is very small therefore is displaced to a greater extent.
Can **impair blood supply of the popliteal artery**
