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Lower Limbs 1 PDF
Lower Limbs 1 PDF
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The Lower Limbs
Supports the weight of the body and
transfers that support to the axial
skeleton across the hip and sacroiliac
joints
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Regions of the Lower Limb
The gluteal region
the transitional region between the trunk and free lower
limbs.
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Regions of the Lower Limb
The leg region
the part that lies between the knee and the narrow,
distal part of the leg. It includes most of the tibia
(shin bone) and fibula (calf bone)
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Pelvic (hip) Girdle
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Coxal Bone Markings
Ilium
Ischium
Pubis
Acetabulum
Iliac Crest
Greater Sciatic
Notch
Obturator Foramen
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Pelvis
Combination of the sacrum,
coccyx, and the 2 hip bones
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Pelvis
Ilium
Ischium
Pubis
Pubic Symphysis
Sacrum
Coccyx
Pelvic Brim
Pelvic Inlet
Pelvic Outlet
Pubic Arch
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X-Ray of Pelvis
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X-Ray of Pelvis
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Comparison of Male and Female
Pelvis
Point of Female Male
Comparison
Measurement
of the size of
the inlet and
outlet of the
birth canal.
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Pelvic Insufficiency Fractures
Thin, weakened, osteoporotic bone trying
to carry the normal load of the body is
prone to fracture
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Nelaton’s line
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Normal angle Coxa vara Coxa valga
of inclination (abnormally decreased angle of (abnormally increased
1250-1300 inclination, it occurs in fractures angle of inclination, in
of the neck of the femur and cases of congenital
slipping of the femoral dislocation of the hip)
epiphysis )
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LOWER LIMB
30 bones in each
Femur
Patella
Tibia
Fibula
Tarsals
Metatarsals
Phalanges
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Femur
Longest, strongest
heaviest bone in
the body
Diaphysis has a
medial bend to
bring knees closer
to the midline of
the body
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Femur
Head
Neck
Trochanter
Condyles
Patellar Surface
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Congenital Hip Dislocation
In the United States, about 1.5 in
1000 infants are born with
congenital hip dislocation
Girls are affected more often than
boys.
About 60% of affected children are
firstborns
Ortolani’s test of hip abduction
confirms the diagnosis
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Head and Neck
Head
Directed medially, upward, and slightly forward to fit into the
acetabulum.
Has a depression in its articular surface, the fovea capitis
femoris, to which the ligamentum capitis femoris is attached.
Neck
Connects the head to the body (shaft), forms an angle of about
125 degrees with the shaft, and is a common site of fractures.
Is separated from the shaft in front by the intertrochanteric
line, to which the iliofemoral ligament is attached.
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Trochanters
Greater Trochanter
Projects upward from the junction of the neck with the shaft.
Provides an insertion for the gluteus medius and minimus,
piriformis, and obturator internus muscles.
Receives the obturator externus tendon on the medial aspect of
the trochanteric fossa.
Lesser Trochanter
Lies in the angle between the neck and the shaft.
Projects at the inferior end of the intertrochanteric crest.
Provides an insertion for the iliopsoas tendon.
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Femoral Head Fractures
The Garden classification
identifies four fracture types:
I: impaction of superior portion
of femoral neck (incomplete
fracture)
II: nondisplaced fracture
(complete fracture)
III: partial displacement
between femoral head and neck
IV: complete displacement
between femoral head and neck
The occurrence of
complications related to
nonunion and avascular
necrosis of the femoral head
increases from type I to IV.
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Linea Aspera and Pectineal Line
Linea Aspera
Is the rough line or ridge
on the body (shaft) of
the femur.
Exhibits lateral and
medial lips that provide
attachments for many
muscles and the three
intermuscular septa.
Pectineal Line
Runs from the lesser
trochanter to the medial
lip of the linea aspera.
Provides an insertion for
the pectineus muscle.
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Adductor Tubercle
Adductor Tubercle
A small prominence at the uppermost
part of the medial femoral condyle.
Provides an insertion for the adductor
magnus muscle.
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Patella
Largest Sesamoid bone
Attaches to the tibial
tuberosity by a
continuation of the
quadriceps tendon called
the patellar ligament.
Functions to obviate wear
and attrition on the
quadriceps tendon as it
passes across thetrochlear
groove and to increase the
angle of pull of the
quadriceps femoris,
thereby magnifying its
power.
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Patellofemoral stress syndrome
AKA “Runner’s
Knee”
Patella does not
glide up and down
between the
femoral condyles
but rather
laterally causing
pain.
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Tibia
Is the weight-bearing medial
bone of the leg
Has the tibial tuberosity into
which the patellar ligament
inserts.
Has medial and lateral condyles
that articulate with the condyles
of the femur.
Has a projection called the
medial malleolus with a
malleolar groove for the
tendons of the tibialis posterior
and flexor digitorum longus
muscles and another groove
(posterolateral to the malleolus
groove) for the tendon of the fl
exor hallucis longus muscle. It
also provides attachment for the
deltoid ligament.
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Shin Splints
A spectrum of tibial
stress injuries is likely
involved in MTSS,
including tendinopathy,
periostitis, periosteal
remodeling, and stress
reaction of the tibia.
Dysfunction of the
tibialis posterior,
tibialis anterior, and
soleus muscles are
also commonly
implicated
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Shin Splints
Medial tibial stress
syndrome (MTSS) is an
overuse injury or
repetitive-stress injury
of the shin area.
Various stress reactions
of the tibia and
surrounding
musculature occur
when the body is
unable to heal properly
in response to
repetitive muscle
contractions and tibial
strain.
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Fibula
Has little or no function in weight
bearing but provides attachment for
muscles.
Has a head (apex) that provides
attachment for the fi bular collateral
ligament of the knee joint.
Has a projection called the lateral
malleolus that articulates with the
trochlea of the talus; lies more
inferior and posterior than the
medial malleolus; and provides
attachment for the anterior talofi
bular, posterior talofi bular, and
calcaneofi bular ligaments. It also
has the sulcus for the peroneus
longus and brevis muscle tendons.
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The Foot
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The Foot
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Regions of Foot
Forefoot
Metatarsals
Phalanges
Midfoot
Navicular
Cuboid
3 Cuniforms
Hindfoot
Calcaneus
Talus
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Bones
Talus
Calcaneus
Sustentaculum Tali
Peroneal Tubercle
Cuboid
Navicular
3 Cuneiforms
5 metatarsals
5 phalanges (proximal, middle, distal)
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Talus
Transmits the weight of the body from the tibia to the foot and is
the only tarsal bone without muscle attachments.
Has a neck with a deep groove, the sulcus tali, for the
interosseous ligaments between the talus and the calcaneus.
Has a body with a groove on its posterior surface for the fl exor
hallucis longus tendon.
Has a head, which serves as keystone of the medial
longitudinal arch of the foot.
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Calcaneus
Is the largest and strongest bone of the foot and lies below the
talus.
Forms the heel of the foot, articulates with the talus superiorly
and the cuboid anteriorly, and provides an attachment for the
Achilles tendon.
Has a shelf-like medial projection called the sustentaculum tali,
which supports the head of the talus (with the spring ligament)
and has a groove on its inferior surface for the flexor hallucis
longus tendon (which uses the sustentaculum tali as a pulley).
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Calcaneus
Is the largest and strongest bone of the foot and lies below the
talus.
Forms the heel of the foot, articulates with the talus superiorly
and the cuboid anteriorly, and provides an attachment for the
Achilles tendon.
Has a shelf-like medial projection called the sustentaculum tali,
which supports the head of the talus (with the spring ligament)
and has a groove on its inferior surface for the flexor hallucis
longus tendon (which uses the sustentaculum tali as a pulley).
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Ankle Fractures
Ankle fractures refer to fractures of the distal tibia,
distal fibula, talus, and calcaneus.
Because an ankle fracture often presents with
symptoms similar to those of an ankle sprain, a
complete and thorough examination of the
involved extremity is needed to avoid
misdiagnosis and prevent unnecessary
radiographs.
Indicators suggesting fracture include gross
deformity, swelling (especially perimalleolar),
bony tenderness, discoloration, and ecchymosis.
Inability to bear weight on the injured foot also
indicates a fracture.
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Tarsal Fracture
The calcaneus is the most frequently fractured
tarsal bone.
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Great Saphenous Vein
Drains the medial end of dorsal
venous arch of foot
Tributaries:
Superficial lateral femoral v.
Superficial medial femoral
v.
External pudendal v.
Superficial epigastric v.
Superficial iliac circumflex
v.
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Superficial epigastric v.
External pudendal v.
Superficial lateral femoral v.
Superficial medial femoral v.
Great saphenous v.
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Varicose Veins
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Superficial Arteries and Nerves
Superficial arteries:
superficial epigastric a.
external pudendal a.
Cutaneous nerves:
lateral femoral cutaneous n.
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Lateral femoral cutaneous n.
Cutaneous branches of
obturator n.
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Superficial inguinal lymph nodes
Superior group:
Lie just distal to the inguinal
ligament
Receive lymph vessels from
anterior abdominal wall below
umbilicus, gluteal region, perineal
region, external genital organs
Inferior group:
Lie vertical along the terminal
great saphenous v.
Receives all superficial lymph
vessels of lower limb, except for
those from the posterolateral part
of calf
Efferent vessels drain into the
deep inguinal ln. or external iliac ln.
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Fascia Lata
Fascia lata
The deep fascia encloses the thigh
like a trouser leg.
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Case 9
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Questions to be Answered
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