What lies deep to the skin?
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Subcutaneous tissue (superficial fascia).
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What lies deep to the skin?
Subcutaneous tissue (superficial fascia).
What can cause fractures of the talar neck?
Severe dorsiflexion of the ankle, such as pressing hard on the brake pedal during a collision.
What type of tissue makes up the subcutaneous tissue?
Loose connective tissue.
What type of fracture is commonly associated with a hard fall onto the heel?
Calcaneal fracture.
Where do fibular fractures commonly occur?
2–6 cm proximal to the distal end of the lateral malleolus.
What is the function of the sesamoid bones of the great toe?
They bear the weight of the body, especially during the latter part of the stance phase of walking.
What may happen to the body of the talus in severe cases of talar neck fractures?
It may dislocate posteriorly.
What does the subcutaneous tissue contain?
Fat, cutaneous nerves, superficial veins, lymphatic vessels, and lymph nodes.
What are fibular fractures often associated with?
Fracture–dislocations of the ankle joint and tibial fractures.
What is a comminuted fracture?
A fracture where the bone is broken into several pieces.
When do sesamoid bones begin to ossify?
During late childhood.
What typically causes metatarsal fractures?
When a heavy object falls on the foot.
Which veins are included in the superficial veins of the subcutaneous tissue?
Great and small saphenous veins and their tributaries.
What causes fibular fractures during a slip?
The foot is forced into an excessively inverted position, tearing ankle ligaments.
Why is a calcaneal fracture usually disabling?
Because it disrupts the subtalar (talocalcaneal) joint.
What type of injury may result in a fracture of the sesamoid bones?
A crushing injury.
What supplies the skin of the lower limb?
Cutaneous nerves in the subcutaneous tissue.
What is the stand-easy position?
A position where the hip and knee joints are extended and in their most stable positions.
What happens to the talus during a slip that leads to fibular fractures?
It is forcibly tilted against the lateral malleolus, potentially shearing it off.
Which bones articulate at the subtalar joint?
The talus and the calcaneus.
What do the deep veins usually occur as?
Duplicate or multiple accompanying veins.
When do sesamoid bones develop?
Before birth.
What age group is most affected by dislocated epiphysis of the femoral head?
Older children and adolescents (10–17 years of age).
From which spinal nerves do some proximal unisegmental nerves arise?
T12 or L1 spinal nerves.
Why are the hip and knee joints stable in the stand-easy position?
Due to maximal contact of articular surfaces for weight transfer and taut supporting ligaments.
What three primary bones form the hip bone?
Ilium, ischium, and pubis.
What are fractures of the hip bone commonly referred to as?
Pelvic fractures.
What is the significance of dermatomes in the lower limb?
They represent the segmental pattern of distribution of sensory nerve fibers.
What is the function of multiple perforating veins?
To shunt blood from the superficial veins to the deep veins.
Why is awareness of the nutrient foramen location in the fibula important?
It is crucial for performing free vascularized fibular transfers.
What causes the epiphysis of the femoral head to slip away from the femoral neck?
Weakened epiphysial plate.
What are the branches of the lumbar and sacral plexuses responsible for?
Supplying cutaneous nerves to the lower limb.
How are the veins of the lower limb categorized?
Into superficial and deep groups.
What does maximal contact of articular surfaces facilitate?
Weight transfer.
How are the hip bones connected to the sacrum?
Posteriorly.
What is the common misconception about the term 'hip fracture'?
It is often incorrectly applied to fractures of the femoral head, neck, or trochanters.
What is the angle of inclination between in the context of coxa vara and coxa valga?
Between the long axis of the femoral neck and the femoral shaft.
Which dermatome map is preferred by many clinicians?
The map according to Foerster (1933) due to its correlation with clinical findings.
Where do the superficial lymphatic vessels converge?
Toward and accompany the great saphenous vein.
Where is the nutrient foramen typically located in the fibula?
In the middle third of the fibula.
What types of trauma can lead to dislocated epiphysis of the femoral head?
Acute trauma or repetitive microtraumas.
Where do superficial veins course?
Within the subcutaneous tissue.
What are the areas of skin supplied by individual spinal nerves called?
Dermatomes.
What is the significance of the axial line in dermatome maps?
It is the line of junction of dermatomes supplied from discontinuous spinal levels.
Where do the hip bones join each other?
At the pubic symphysis.
What type of fractures may occur during sports involving sudden acceleration or deceleration?
Avulsion fractures of the hip bone.
What condition is characterized by a decreased angle of inclination?
Coxa vara.
What is the advantage of the Keegan and Garrett (1948) dermatome map?
It is preferred for its aesthetic uniformity and correlation with development.
Into which lymph nodes do the superficial lymphatic vessels drain?
The inferior (vertical) group of superficial inguinal lymph nodes.
What is the significance of the nutrient foramen for grafting?
It allows for blood supply to the medullary cavity and compact bone.
What movements place increased shearing stress on the epiphysis?
Abduction and lateral rotation of the thigh.
Where are deep veins located?
Internal to the deep fascia.
How is the dermatomal pattern of skin innervation affected during development?
It is distorted by limb lengthening and torsion.
What do the cutaneous nerves of the lower limb convey?
Sensory fibers to the cutaneous nerves.
What structure do the hip bones form?
The pelvic girdle.
What condition is characterized by an increased angle of inclination?
Coxa valga.
What happens during an avulsion fracture?
A small part of bone with a piece of a tendon or ligament attached is torn away.
What is intraosseous (IO) infusion?
A method of delivering hydration, blood, and medications directly into the medullary cavity of a bone.
How do adjacent dermatomes behave in the lower limb?
They overlap considerably, except along the axial line.
Why is the anterior tibia accessible for bone grafting in children?
Due to its extensive subcutaneous location.
Where does the great saphenous vein pass in relation to the medial malleolus?
Anterior to the medial malleolus.
What condition may result from the dislocation of the epiphysis?
Progressive coxa vara.
What may happen if the saphenous nerve is cut during a saphenous cutdown?
The patient may complain of pain or numbness along the medial border of the foot.
What type of fractures are common in people who take long hikes without conditioning?
Transverse march (stress) fractures of the inferior third of the tibia.
What do deep veins usually accompany?
Arteries.
What type of fibers transmit impulses to the muscles of the lower limb?
Somatic motor (general somatic efferent) fibers.
What is the function of the hip bones when standing?
To receive half the weight of the upper body.
What does the term 'vara' or 'varus' indicate?
A bone or joint that deviates toward the midline.
Where do avulsion fractures typically occur?
At apophyses, where muscles or ligaments are attached.
When is IO infusion primarily used?
In cases of traumatic shock and in children with circulatory collapse.
What is another use of the anterior tibia in children?
It is used as a site for intraosseous infusion in dehydrated children or those in shock.
How far posterior to the patella does the great saphenous vein pass?
Approximately a hand’s breadth.
What is a common initial symptom of a dislocated epiphysis of the femoral head?
Hip discomfort that may be referred to the knee.
What causes enlargement of the superficial inguinal lymph nodes?
Abrasions and minor sepsis caused by pathogenic microorganisms or their toxins.
What may cause a fracture of the anterior cortex of the tibia?
Strain from long hikes.
What is shown in the inset of Figure 7.15?
The proximal ends of the femoral and great saphenous veins opened and spread apart.
What do the anterior and posterior intermuscular septa attach to?
The corresponding margins of the fibula.
What is a myotome?
The unilateral embryological muscle mass receiving innervation from a single spinal cord segment or spinal nerve.
What vein accompanies the small saphenous vein in the posterolateral leg?
The great saphenous vein.
What happens to the weight distribution during walking?
The hip bones receive all the weight periodically.
What does the term 'valga' or 'valgus' indicate?
A bone or joint that deviates away from the midline.
What are common areas for avulsion fractures of the hip bone?
Anterior superior and inferior iliac spines, ischial tuberosities, and ischiopubic rami.
What is the most common site for IO infusion?
The proximal tibia.
What lymphatics follow the superficial veins in the lower limb?
Lymphatics that follow the saphenous veins to the superficial inguinal nodes.
What should be examined when inguinal lymph nodes are enlarged?
The entire field of drainage, including the trunk inferior to the umbilicus and the entire lower limb.
What type of fracture can occur from indirect violence applied to the tibial shaft?
Fracture when the bone turns with the foot fixed during a fall.
How many compartments does the leg have?
Three compartments: anterior, lateral, and posterior.
Where do the lymphatics from the posterolateral leg initially drain?
Into the popliteal lymph nodes.
How do lower limb muscles typically receive motor fibers?
From several spinal cord segments or nerves.
What do the thick parts of the hip bone do?
Transfer weight to the femur.
What effect does coxa vara have on the lower limb?
Causes mild shortening and limits passive abduction of the hip.
What is required to confirm a diagnosis of a dislocated epiphysis of the head of the femur?
Radiographic examination of the superior end of the femur.
Why is the proximal tibia preferred for IO infusion?
Due to the thinness of the skin and the existence of landmarks for correct insertion.
Where do lymphatics that follow deep veins drain to?
Deep inguinal nodes.
Why should the possibility of metastasis from the uterus be considered in female patients with enlarged inguinal lymph nodes?
Because lymphatic drainage from the uterine fundus may flow to the superficial inguinal lymph nodes.
What activity may lead to a diagonal fracture of the tibial shaft?
Severe torsion during skiing.
What is the primary function of the pelvic girdle?
To encircle and protect the pelvic viscera, particularly the reproductive organs.
What are the functions of the anterior compartment of the leg?
Dorsiflexion.
What nodes do the efferent vessels from the popliteal lymph nodes join?
Deep inguinal lymph nodes.
What can the strength and ability to perform particular movements indicate?
The level of spinal cord injury or nerve impingement.
What is the purpose of the thin parts of the hip bone?
Provide a broad surface for attachment.
What factors can influence the angle of inclination of the femur?
Age, sex, development of the femur, and pathological processes like rickets.
Which part of the femur is most frequently fractured?
The neck of the femur.
What are other sites for IO infusion?
Distal femur, tibia, fibula, proximal humerus, and manubrium.
What is a common condition associated with the great saphenous vein?
Thrombophlebitis, leading to varicose veins.
What types of fractures are common in soccer and basketball players?
Fractures of the lateral and medial malleoli.
What is a 'boot-top fracture'?
A fracture resulting from a high-speed forward fall while skiing, angling the leg over the rigid ski boot.
What nodes does lymph drainage from the lower limb pass to after the inguinal nodes?
External and common iliac nodes of the trunk.
What is the largest bone in the human body?
The femur.
How can a nerve block be achieved in the lower limbs?
By making perineural injections of anesthetics close to the nerves.
What is the function of venous valves in the great saphenous vein?
To prevent reflux of blood and ensure unidirectional flow.
What are myotomes related to?
Segmental innervation of muscle groups and movements of the lower limb.
What separates the superficial and deep plantarflexor muscles in the posterior compartment?
The transverse intermuscular septum.
What primarily drains the dorsal venous arch?
The saphenous veins.
Why is the neck of the femur particularly vulnerable to fractures?
Because it is the narrowest and weakest part of the bone and lies at an angle to the line of weight bearing.
How far from the tibial tuberosity should the needle be inserted for IO infusion?
Approximately 2 cm distal and slightly medial.
Where are varicose veins commonly found?
In the posteromedial parts of the lower limb.
What is a common cause of metatarsal fractures in dancers?
Losing balance and putting full body weight on the metatarsal.
What reflects the cutaneous innervation of the lower limb?
The original segmental innervation of the skin via separate spinal nerves and plexus formation.
Why can fibular fractures be painful?
Due to disrupted muscle attachments.
Where can the femoral nerve be blocked?
2 cm inferior to the inguinal ligament, approximately a finger’s breadth lateral to the femoral artery.
Why are tibial fractures in children more serious if they involve the epiphysial plates?
Because continued normal growth of the bone may be jeopardized.
What adaptations does the femur have for bipedal locomotion?
It has a bend (angle of inclination) and has twisted (medial rotation and torsion).
Where can the cuboid bone be palpated?
On the lateral aspect of the foot, posterior to the base of the 5th metatarsal.
Where are the superficial veins located in the lower limb?
In the subcutaneous tissue.
What are the fascial compartments of the lower limbs?
Generally closed spaces ending at the joints.
How many valves does the great saphenous vein typically have?
10–12 valves.
What veins form the posterior tibial and fibular veins?
Medial and lateral plantar veins.
How does age affect the vulnerability of the femur to fractures?
It becomes increasingly vulnerable with age, especially in females due to osteoporosis.
What types of needles are used for IO infusion?
Special needles designed for manual insertion or battery-powered/impact-driven devices.
What does the fascia lata enclose?
The large thigh muscles, especially laterally.
What happens to the valves in varicose veins?
They become incompetent due to dilation or rotation.
What type of fractures may result from prolonged walking?
Fatigue fractures of the metatarsals.
Which nerves primarily supply the thigh?
Lateral and posterior cutaneous nerves of the thigh and anterior cutaneous branches of the femoral nerve.
What symptoms may occur if the saphenous nerve is affected during a nerve block?
Paresthesia, including tingling, burning, or tickling radiating to the knee and medial side of the leg.
How does a fibular fracture affect walking?
It compromises walking due to the bone's role in ankle stability.
At what age does the primary ossification center for the superior end of the tibia typically join the shaft?
During adolescence, usually between 16–18 years of age.
What is demonstrated in relaxed standing regarding the line of gravity?
The relationship of the line of gravity to the transverse rotational axes of the pelvis and lower limb.
What is the gait cycle?
The activity of one limb between two repeated events of walking.
What role does the angle of inclination play in the femur?
It allows increased leverage and superior placement of the abductors.
What is the relationship between deep veins and major arteries in the lower limb?
Deep veins accompany all major arteries.
What can cause increased intracompartmental pressure in the lower limb?
Trauma, burns, intense muscle use, or blunt trauma.
What forms a prominence on the medial aspect of the foot?
The head of the 1st metatarsal.
What is the role of the musculovenous pump?
To help return blood to the heart against gravity.
Where do the deep veins from the leg flow into?
The popliteal vein.
What are two common locations for proximal femur fractures?
Transcervical (middle of neck) and intertrochanteric.
What is the risk associated with IO infusion?
Osteomyelitis.
What is revealed when the anterior skin and subcutaneous tissue of the lower limb are removed?
The deep fascia.
What is the iliotibial tract?
A broad band of fibers that is the shared aponeurosis of the tensor fasciae latae and gluteus maximus muscles.
What is the result of incompetent valves in varicose veins?
Blood flows inferiorly in the veins.
What happens to the 5th metatarsal during sudden inversion of the foot?
The tuberosity may be avulsed by the tendon of the fibularis brevis muscle.
What is the purpose of bone grafts?
To replace a destroyed segment of a major bone and avoid amputation.
How many phases are typically described in the gait cycle?
Eight phases.
What adjustments are necessary to maintain the relaxed standing position?
Only minor postural adjustments by the extensors of the back and plantarflexors of the ankle.
What nerves supply the leg and dorsum of the foot?
Saphenous, sural, and fibular nerves.
What condition may result from disruption of the epiphysial plate at the tibial tuberosity?
Osgood-Schlatter disease.
What is the function of the patella?
It provides mechanical advantage in extending the knee.
What are the two major superficial veins in the lower limb?
The great and small saphenous veins.
What happens when intracompartmental pressure increases?
It can compress small vessels and nerves, leading to ischemia and potential permanent injury.
What is the most common type of lower limb injuries?
Knee, leg, and foot injuries.
What is formed when tributaries from the medial and posterior aspects of the thigh unite?
An accessory saphenous vein.
What does the popliteal vein become in the thigh?
The femoral vein.
How long should IO infusion be replaced with peripheral venous or central line access?
Within 24 hours.
What type of trauma usually causes proximal femur fractures?
Indirect trauma, such as stumbling or stepping down hard.
What reinforces the fascia lata laterally?
Longitudinal fibers of the iliotibial tract, and the common aponeurotic tendon of the gluteus maximus and tensor fasciae latae.
Where does the iliotibial tract extend from and to?
From the iliac tubercle to the anterolateral tubercle of the tibia (Gerdy tubercle).
What are the symptoms of Deep Venous Thrombosis (DVT)?
Swelling, warmth, and erythema.
What is an avulsion fracture of the 5th metatarsal commonly associated with?
Pain and edema at the base of the 5th metatarsal, and may be associated with a severe ankle sprain.
What are intracapsular fractures?
Fractures occurring within the hip joint capsule.
Which bone is commonly used for grafting?
The fibula.
What simplification is made in the description of the gait cycle?
Two phases have been combined for simplification.
What provides passive support in the relaxed standing position?
The ligaments of the hip and knee being tightly stretched.
Which nerves supply the plantar aspect of the foot?
Calcaneal branches of the tibial and sural nerves, and medial and lateral plantar nerves.
What is the relationship between the tibia and fibula?
The tibia bears weight, while the fibula provides additional surface area for muscle attachment.
At what age does the tibial tuberosity usually form?
Approximately 10 years of age.
What can cause external pressure on veins during a prolonged hospital stay?
Bedding, tight casts, or bandages.
How is the great saphenous vein formed?
By the union of the dorsal vein of the great toe and the dorsal venous arch of the foot.
What percentage of lower limb injuries are hip injuries?
Less than 3%.
Where does the great saphenous vein empty?
Into the femoral vein.
What is a common sign of arterial compression in the lower limb?
Loss of distal leg pulses.
What happens to blood flow when a person stands quietly?
Blood flow is slower due to gravity.
What do the fascial compartments of the thigh and leg contain?
Muscles sharing common functions and innervation.
What contributes to the instability of proximal femur fractures?
The angle of inclination and muscle spasm, which can cause limb shortening.
How are the thigh muscles separated?
Into three compartments: anterior, medial, and posterior.
What is a significant cause of thrombus formation?
Venous stasis (stagnation).
What is the os trigonum?
An accessory ossicle that may form when the secondary ossification center of the talus fails to unite with its body.
What complication arises from intracapsular fractures?
Degeneration of the femoral head due to vascular trauma.
Where does the center of gravity fall during relaxed standing?
In the posterior third of a median plane between the slightly parted and laterally rotated feet.
Can normal activities like walking and running continue after a segment of the fibula is removed?
Yes, they can be normal even after removal.
What is the primary function of the lower limbs?
Standing and walking.
How do the tibia and fibula contribute to locomotion?
They have become permanently pronated to provide a stable stance.
What condition may develop due to muscular inactivity during long flights?
Deep vein thrombosis (DVT) with thrombophlebitis.
Where are valves more numerous, in superficial or deep veins?
In deep veins.
What anatomical feature helps reduce back pressure in the great saphenous vein?
The valvular mechanism that breaks the column of blood into shorter segments.
What is the primary cause of most lower limb injuries?
Acute trauma during contact sports and overuse during endurance sports.
What is a fasciotomy?
An incision of overlying fascia or a septum to relieve pressure in compartments.
What prevents reverse blood flow in the veins?
Competent valves.
How does the subcutaneous tissue change at the knee?
It loses its fat and blends with the deep fascia.
What is impaction in the context of femoral fractures?
Overriding of fragments resulting in foreshortening of the limb.
What does a peripheral nerve sensitizing an area of skin represent?
More than one segment of the spinal cord.
