UNIVERSITY OF NAIROBI

DEPARTMENT OF HUMAN ANATOMY AND PHYSIOLOGY

SURGICAL ANATOMY

MODULE TWO: LIMBS & SPINE

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SECTION ONE: OSTEOLOGY
Kirsteen o. Awori
1.0. LOWER LIMB BONES

1.1. The pelvis

Review the development of this bone and state the relevance to developmental dysplasia of the hip (DDH) and the surgery of pelvic
osteotomy for this abnormality.

Are you familiar with Risser’s sign in the management of adolescent idiopathic scoliosis? What is its embryological basis?

Study the anatomical parts of the pelvis displayed, relate to the radiographic lines/parameters shown. This is important in diagnosis of
pelvic ring fractures and their operative management with the help of fluoroscopy.

Review the variant morphology of the sacrum relevant to iliosacral screw fixation.

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1.2. The femur

1.2.1. Remind yourself about all the parts of the femur

1.2.2. Review considerations in the age-related changes in the neck-shaft angle. What is the surgical relevance of the variance in the
femoral neck-shaft angle?

1.2.3. Define the angle of femoral anteversion (torsion) and indicate its relevance in hip replacement surgery.

1.2.4. State the relevance of the shape of the femoral shaft in the biomechanics of femoral shaft plating and intramedullary nailing

1.2.5. What morphological parameters of the distal femoral epiphysis are relevant in the following surgeries:

a) Angle- blade plating and dynamic condylar screw (DCS) plating

b) Femoral tunnelling in anterior cruciate ligament (ACL) reconstruction
c) Total knee replacement (TKR)

1.3. The tibia

1.3.1. Remind yourself the anatomy of the proximal tibial epiphysis including
a) ACL footprint and relevance in tunnel placement for reconstruction of this ligament.
b) Meniscal attachments
c) Foot print of the patella tendon and relevance in TKR and conditions such as Osgood Schlatter’s disease

1.3.2. Locate the nutrient artery of the tibia and discuss in detail the pattern of blood supply to the tibia. State the relevance of
this pattern to healing of fractures of this bone and reconstruction of flaps in the leg.

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1.4. The fibula

1.4.1. Locate the nutrient artery of the tibia and discuss in detail the pattern of blood supply to the fibula. State the relevance of
this pattern to the design of vascularised bone graft using this bone and in management of bone pathologies in the leg
especially in the paediatric age group.

1.4.2. What are the components of the distal lower extremity syndesmosis? What is the anatomy behind placement of
syndesmotic screw and subsequent removal?

1.4.3. Which ligaments that are part of the lateral ligament complex of the ankle are attached to the fibula.

1.5. The talus

1.5.1. Name the parts of the talus relevant to the pattern of blood supply to this bone.
1.5.2. What is the preferred access to insert screws to fix neck fractures of this bone?
1.5.3. Relate the shape of trochlea tali to the stability of the ankle joint.
1.5.4. What are the planes of motion of the ankle joint?

1.6. The calcaneus

1.6.1. Name the parts of the calcaneus

1.6.2. Define Bohler’s angle and state its relevance in correction of calcaneal fractures.

1.7. The foot skeleton.

1.7.1. Review the foot skeleton
1.7.2. Review the arches of the foot
1.7.3. Review the phases of the gait cycle.

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