Quiz 2 - Lec 9-10 Flashcards
(88 cards)
1
Q
what is the longest bone in the human body?
A
femur
2
Q
parts of the femur?
A
diaphysis (shaft)
4 epiphyses (secondary ossificaiton centers that will fuse by the mid-20s
3
Q
relevant lines/angles in the femur bone?
A
- line of gravity
- long axis of diaphysis
- angle of oliquity/bicondylar angle (10-15 degrees), which is the normal anatomical orientation of femur during quiet standing/upright
4
Q
angle of inclination
A
angle between long axis of head and neck of femur
average is 126º –> less in females due to greater distance between acetabulae (due to wider true pelvis)
5
Q
how does angle of inclination change as you age?
A
angle of inclination decreases to 120º (from 126º)
6
Q
CC: coxa vara
A
angle of inclination is LESS THAN 120º –> producing stress on femoral neck
7
Q
CC: coxa valga
A
angle of inclination: > 135º (normal is 120-135)
Greater than 135º results in INCREASED joint pressure at 180; no skeletal checks restricting ROM –> predisposes to dislocation
8
Q
Q-angle
A
q-angle = quadriceps angle
8º angle between ASIS and line of gravity (to midpoint of patella)
9
Q
CC: genu varum & Q-angle
A
(bow-legged); tib/fib is towards midline
SMALL OR NEGATIVE Q-ANGLE
10
Q
CC: genu valgun & Q-angle
A
knock-kneed; tib/fib away from midline
Q-angle is greater than 17 degrees –> causes undue stress
11
Q
how to “side” the femur?
A
- Hold the femur in front of you with the smooth side of the shaft against your fingers and the side with the vertical ridge against your thumb.
- If the head of the femur faces medially and the rough greater trochanter faces laterally and to your right, it is from the right side.
12
Q
femoral head: characteristics
A
- Conforms to a spheroidal geometric shape (2/3 of a sphere)
- Nearly all articular, except for the fovea capitis femoris
- Sharply defined border, except anterosuperiorly
- Covered with hyaline cartilage, except in the fovea
- Subject to osteoarthritic disease
13
Q
femoral neck: shape and orientation
A
- hourglass in shape
- set obliquely to the shaft (15º anterior to a frontal plane)
- (head and neck are angled away from the surface when placed on flat table –> angle of torsion)
14
Q
angle of torsion
A
also called angle of declination
- formed by looking at the relationship between the axis of the femoral head and neck and the femoral condyles
15
Q
CC: how to treat torsional femur deformities?
A
subtrochanteric derotational osteotomy
16
Q
CC: what is a presentation of torosional femur deformities?
A
Commonly presents as “in-toeing”, because with ABNORMAL FEMORAL NECK ANTEVERSION, the patient will in-toe to place the femur in a better spot in the acetabulum
17
Q
which torosional femur deformity is associated with IN-TOEING?
(anteversion/retroversion)
A
femoral neck ANTEVERSION
18
Q
where does anterior side of femoral neck join the femoral shaft?
A
intertrochanteric line, which extends from greater to lesser trochanter
19
Q
iliotrochanteric band: what attaches here?
A
part of the iliogemoral ligament of hip joint capsule
20
Q
where does posterior side of femoral neck join the femoral shaft?
A
intertrochanteric CREST
(more pronounced than the line and found posteriorly)
21
Q
where does femoral neck end SUPERIORLY?
A
greater trochanter
22
Q
where does femoral neck end INFERIORLY?
A
LESSER trochanter
23
Q
intertrochanteric line turns posteriorly and becomes….
A
the spiral line
24
Q
greater trochanter: functional sides/surfaces
A
medial surface: concave w/ trochanteric fossa posteriorly
lateral surface: convex w/ ridge line
25
lesser trochanter: shape, location
* pyramidal in shape
* sits at inferior end of intertrochanteric crest and superior to pectinal line
* (bump at end of trochanter)
26
femoral shaft: shape
* expanded at ends (elongated hourglass shape)
* anterior bowing
* round in x-section
27
**linea aspera:** what does it mean and how is it formed?
linea aspera = rough line
medial lip is formed by: pectineal line and spiral line, and medial supracondylar ridge
lateral lip is formed by: gluteal tuberosity, lateral supracondylar ridge
28
femoral condyles: number and orientation
2 condyles - medial and lateral
* project posteroinferiorly
* highly curved posteriorly
* **medial condyle projects more inferiorly when held in _vertical position (_**_not anatomical)_
29
the long axis of which femoral condyle is more ANTERIOPOSTERIOR?
long axis of the **LATERAL** condyle
30
the long axis of which femoral condyle is more POSTEROMEDIAL?
long axis of the MEDIAL condyle is more posteromedial
31
where do the femoral condyles meet?
**anteriorly**
at the **patellar articular surface**
32
how many femoral EPIcondyles?
2-
medial epicondyle and lateral epicondyle
33
difference between CONDYLE and EPICONDYLE
a **condyle** is smooth and round whereas **epicondyle** is rough.
**Epicondyle** is a projection on the condyle.
The main difference between condyle and epicondyle is that **_condyle forms an articulation with another bone_**, whereas **_epicondyle provides sites for the attachment of muscles_**
34
**adductor tubercle**:
location &relationships
* small tubercle at the summit of the medial condyle, where the medial ridge of the popliteal surface ends
* found on **medial side** of femur
* affords **insertion** to the tendon of the Adductor magnus
35
**popliteal groove**:
location and relationship
* a small depression found on lateral surface of femur, b/w the lateral condyle and lateral epicondyle
* from this, a smooth well-marked groove curves obliquely upward and backward to the posterior extremity of the condyle. This **popliteal groove** is separated from the articular surface of the condyle by a prominent lip across which a second, shallower groove runs vertically downward from the depression.
* The **Popliteus** arises from the depression;
36
where is popliteus tendon located?
Popliteus tendon arises from the depression (popliteal groove);
its tendon lies in the **_oblique_ groove when the knee is flexed** and in the _v_**_ertical_ groove when the knee is extended**
(oblique groove = flexed, vertical groove = extended)
37
what does the **internal structure of the proximal femur** reflect?
it reflects the diff't kinds of stress upon it
(lamella = thin leaf./scale/plate of bone), or (trabecula = beam or supporting fibers of a structure)
38
how are the **trabeculae** of the femur arranged?
arranged ALONG the lines of greatest compression or stress, to resist the loads placed on the femoral head and neck
39
what forces do the following lamellae types oppose?
* tension lamellae
* pressure lamellae
* tension lamellae - *resist tensile forces*
* pressure lamellae - *resist compression forces*
40
at what angle do the TENSION lamellae and PRESSURE lamellae intersect?
at 90 degree angle
41
calcar femorale: define
thin vertical plate of bone, originates from compact bone of shaft near the linea aspera, and extends into the spongy bone of the neck
* medially, it joins the spongy bone of the neck
* laterally, continues into the wall of the greater trochanter
* lies in plane anterior to the trochanteric crest and lesser trochanter
42
ward's triangle:
other name, definition, clinical relation
* aka **internal femoral triangle**
* an inherently weak area b/w the tension and pressure lamellae
* CC: predisposes the elderly to **_femoral neck fx (hip fxs)_**
43
order of FUSION of secondary ossification centers
*Femur: (Lesser & Greater Harden Cardinal)*
1. **Lesser** trochanter (~18 y/o)
2. **Greater** trochanter (~18-19 y/o)
3. **Head** (~18-20 y/o)
4. **Condyles** (~20-22 y/o)
44
order of APPEARANCE of 2º ossification centers of femur
opposite of fusion order, so the appearance is:
1. **Condyles** (*9th month gestation)*
2. **Head** *(1st 6 months)*
3. **Greater** trochanter *(4th year)*
4. **Lesser** trochanter (*11-14 years)*
45
during which week does the primary ossification center of the femur appear?
week 7
46
**patella**:
type of bone, location, fxn
* "knee cap"
* **Sesamoid** bone w/in quadriceps tendon & patellar tendon/ligament
* serves as fulcrum for quadriceps femoris at end of extension when it is exerting essentially a vertical upward pull
47
what are the 2 surfaces of the patella and how do they differ?
* 2 surfaces (anterior / posterior)
* **Anterior** surface is **rough** with vascular foramina (related to the quadriceps tendon)
* '**Posterior** surface has **large superior articular area** divided by a vertical ridge (lateral side is larger and consistently concave); lower area is for attachment of patellar ligament
48
how do you side a patella?
The larger of the 2 facets will be lateral
49
when do the ossification centers develop in the cartilaginous precursor of the **patella**?
years 3-6 is when these oss centers appear; they fuse soon after
50
CC: patellar anomalies
* bipartite or tripartite patella (usually bilateral) w/synchrondrosis
Remember
***bipartite**:* occurs when the patella (kneecap) is made of two bones instead of a single bone
***tripartite***: when patella is made of 3 bones
***_synchondrosis:_*** an almost immovable joint between bones bound by a layer of cartilage,
51
identify the **base** and **apex** of the patella?
52
clinical correlates of patella
* patellar fx
* deep tendon reflex (L2-L4)
53
**knee joint (femur/tibia/patella)**:
classification, complexity, (monocondylar/condylar)
* classification: **synovial hinge**/ **ginglymus** (modified)
* complexity: **composite (**menisci & 3 articulating surfaces)
* **bicondylar** (2 pairs of condyles)
54
knee joint:
motion
* uniaxial joint
* around a **transverse (medial-lateral) axis**
* w/in **sagittal plane**
* **flexion/extension**, but small amount of "conjunct" rotation w/ the flexed knee
55
What other movements can occur during **flexion**?
Small amounts of passive abduction & adduction can occur during flexion.
3
56
describe the **rotation** at the knee joint
* “**Conjunct**” medial femoral rotation occurs **during the last 30° of extension** (from flexion);
* and corresponding lateral femoral rotation occurs during early flexion (from extension).
57
during which position (flexed/extended) is the **knee more stable osteologically**?
during extension
58
during which position (flexed/extended) is the knee more UNSTABLE (less stable)
during FLEXION
59
what structure helps improve the bony articulation between the femoral and tibial condyles?
menisci
60
**meniscus**: define
crescent-shaped **fibrocartilaginous** anatomical structure that, in contrast to an articular disk, **only partly divides a joint cavity**.
61
how are the menisci attached?
attach loosely to tibia via fibers of the capsule (coronary ligament)
attachments for horns of menisci (in image)
62
are menisci vascular or avascular?
it's a trap - they're both!
* VASCULAR peripherally
* AVASCULAR centrally
63
many common shapes of meniscal tears
how are these repaired?
"inside-out" suture repair for meniscal tears
64
what does the following MRI show?
T2 weighted images show brighter images that are fluid
65
**fibrous joint capsule**:
anterior attachments
there are no anterior attachments for the fibrous joint capsule (green line)
66
where does the **fibrous joint capsule** attach?
* margins of the articular surfaces of femoral and tibial condyles
67
what does the **fibrous joint capsule** enclose posteriorly?
encloses intercondylar fossa
68
capsular ligaments of the fibrous joint capsule?
* oblique popliteal ligament
* arcuate popliteal ligament
69
oblique popliteal ligament:
attachments
* crosses the back of the knee joint
* from: lateral epicondyle of femur/ lateral condyle of femur
* to: medial condyle of tibia
70
arcuate popliteal ligaments:
attachments
* extracapsular ligament of the knee; Y-shaped
* from: head of the fibula
* to: articular capsule of the knee
71
what are the extracapsular ligaments?
1. **tibial collateral** (medial collateral ligament)
2. **fibular collateral** (lateral collateral ligament)
72
the tibial collateral and fibular collateral ligaments are most stable during (FLEXION/EXTENSION)?
during extension; these ligaments are TENSED --\> contributing to knee joint stability
(passive ABduction and ADduction)
73
which collateral ligament prevents ABduction of the knee?
tibial collateral ligament (medial collateral ligament)
* also wider, less cord-like structure
74
which collateral ligament prevents ADduction of the knee?
fibular collateral (lateral collateral ligament)
75
what are the cruciate ligaments of the knee?
intracapsular ligaments include:
1. anterior cruciate ligament (ACL)
2. posterior cruciate ligaments (PCL)
76
mnemonic for orientation and direction of cruciate ligament fibers?
Mnemonic for orientation and direction of fibers
• **APEX**: ACL runs posteriorly and EXternal (lateral) condyle of the femur
• **PAIN:** PCL runs anteriorly, and internally, to inserting into the INternal (medial) condyle of the femur
77
ACL:
when tensed, resists which movements, blood supply, mnemonic
1. tensed in EXTENSION
2. resists anterior displacement of tibia on femur (anterior drawer sign)
3. poor blood supply
4. APEX: ACL runs posteriorly and EXternal (lateral) condyle of the femur
78
PCL:
tensed during, resists movement, blood supply, mnemonic
1. tensed during FLEXION
2. resists **posterior displacement** of tibia on femur (posterior drawer sign)
3. adequate blood supply
4. **PAIN**: : PCL runs anteriorly, and internally, to inserting into the INternal (medial) condyle of the femur
79
where do the ACL and PCL attach?
* at the anterior/ posterior intercondylar areas of tibia
* at medial & lateral sides of intercondylar fossa of femur
80
CC: unhappy triad
| (mechanism of injury, places affected)
* mechanism: ACL limits medial rotation of femur when foot is fixed and knee is flexed
* tears of the:
1. ACL
2. MCL, &
3. MM (medial meniscus)
81
what does this T2 weighted MRI show?
82
when reflecting the anterior portion of the knee, what is seen?
* infrapatellar synovial fold
* infrapatellar fat pad and alar folds
* articular surface of patella
83
What are the major bursa at the knee (4)? list superior to inferior
1. **suprapatellar** bursa
2. **subcutaneous** **prepatellar** bursa
3. **subcutanous** **infrapatellar** bursa
4. **subtendinous** **infrapatellar** bursa
84
which bursa is referred to as "housemaid's knee" when inflamed?
**subcutaneous** prepatellar bursa
85
when bursa is referred to as "clergyman's knee" when inflamed?
**subcutaneous** **infrapatellar** bursa
86
match the 2 bursa with their "common names:
* subcutneous **pre**patellar or subcutaneous **infra**patellar
* clergyman's knee, housemaid's knee
housemaid's knee: subcutaneous PREPATELLAR bursa
clergyman's knee: subcutanous INFRAPATELLAR bursa
87
where does the **popliteal artery** run in relation to the knee? clinical relevance of this?
runs posterior to the knee
* CC: baseball catcher or another role w/ lots of sqatting --\> cuts off blood supply (or would do so without anastomoses/collateral flow)
88
list the innervation of the knee
articular branches of:
* femoral nerve
* posterior division of obturator nerve
* tibial & common fibular (peroneal) nerves
