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LOWER EXTREMITY. Francis Neuffer, MD USC SOM Gross Anatomy / Radiology. OUTLINE. Hip Trauma Knee Degeneration Ankle Vascular Injury Foot Sports Injury. FEMORAL HEAD. ACETABULUM. FEMORAL NECK. AP HIP . GREATER TROCHANTER. FOVEA CAPITIS. LESSER TROCHANTER.

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slide1

LOWER EXTREMITY

Francis Neuffer, MD

USC SOM

Gross Anatomy / Radiology

slide2

OUTLINE

Hip Trauma

Knee Degeneration

Ankle Vascular Injury

Foot Sports Injury

slide3

FEMORAL HEAD

ACETABULUM

FEMORAL NECK

AP HIP

GREATER

TROCHANTER

FOVEA CAPITIS

LESSER

TROCHANTER

CORTICAL BONE

MEDULLARY BONE

slide4

RT. HIP

Pediatric

Adult

slide9

ACETABULAR

FRACTURE

Dashboard fracture

CT SCAN OF THE PELVIS SHOWS FRACTURE

slide10

AVASCULAR NECROSIS

Bone scan

X-ray

MRI

slide12

DESCRIBE

THE

FRACTURE

AP

  • BONE AND WHICH PART
  • FRACTURE ORIENTATION AND PARTS
  • DISPLACEMENT AND ANGULATION
  • JOINT / SOFT TISSUE INVOLVEMENT

LAT

slide13

EXAMPLE

There is an oblique fracture through the diaphysis of the femur with approximately 1cm of lateral and anterior displacement of the distal fragments relative to the proximal fragments. There is no angulation at the fracture margin. There is some shortening due to unopposed muscle pull. The fracture does not extend into the joint.

slide14

DISTAL FEMUR KNEE

Medial epicondyle

Lateral epicondyle

Lateral tibial

condyle

Intercondylar eminence

Medial tibial

condyle

Head of fibula

Tibial tuberosity

slide15

KNEE

LATERAL

AP

slide16

Tendon Rupture

Which One?

slide17

MRI RIGHT KNEE

coronal section

anterior

Scan level

slide18

MEDIAL

-

Sagittal sections

MEDIAL MENISCI

PCL

LATERAL MENISCI

ACL

PATELLA TENDON

LATERAL

slide19

SAGITAL MR KNEE (MID JOINT)

QUADRICEPS TENDON

POSTERIOR CRUCIATE LIGAMENT

Scan level

PATELLA

ANTERIOR CRUCIATE LIGAMENT

PATELLAR TENDON

slide21

NORMAL

QUADRACEPS

TENDON

INJURY

PATELLA

TENDON

INJURY

slide24

POST OPERATIVE LIGAMENT REPAIR

Stabilization of ligament

by surgical graft and screws

slide26

MENISCUS

NORMAL

TORN

slide28

POST OP

KNEE REPLACEMENT

Degenerative

arthritis

POST-OP

slide29

LOWER LEG

TIBIAL

TUBEROSITY

HEAD OF

FIBULA

FIBULA

TIBIA

FIBULA

LATERAL

MALLEOLUS

MEDIAL

MALLEOLUS

AP

LATERAL

slide31

AP ANKLE

Tibial shaft

Fibular

shaft

Medial malleolus

of the tibia

Lateral malleolus

of the fibula

Talus

slide32

LATERAL ANKLE

tibia

fibula

talus

navicular

cuboid

calcaneus

slide33

FRACTURES THROUGH THE

MEDIAL AND LATERAL

MALLEOLI.

slide36

AP FOOT

DIP

PIP

DISTAL PHALANX

MIDDLE PHALANX

PROXIMAL PHALANX

PHALANGES

MTP

CUNIFORMS

METATARSALS

SESAMOID

BONES

3RD

2ND

1ST

IV

III

II

I

V

SCAPHOID

CUBOID

TALUS

TARSALS

CALCANEUS

slide37

LATERAL FOOT

(NAVICULAR)

(3) CUNEIFORMS

TALUS

METATARSALS

PHALANGES

SUSTENTACULUM

TALI

CALCANEUS

CUBOID

SESAMOID

BONE

CALCANEAL

TUBEROSITY

slide38

CALCANEAL FRACTURE

PATIENT FELL OFF OF A LADDER

slide39

DIABETIC

OSTEOMYLITIS

Note air in soft tissues on right due to

bacterial growth.

slide40

BONE SCAN

OSTEOMYELITIS

Increased activity on bone scan supports osteomylitis in metatarsal

slide41

GOUT

Urate crystal deposits cause inflammation

and erosion.

slide43

AP PELVIC ARTERIOGRAM

1

6

  • ABDOMINAL AORTA
  • COMMON ILLIAC ARTERY
  • INTERNAL ILLIAC ARTERY
  • EXTERNAL ILLIAC ARTERY
  • COMMON FEMORAL ARTERY
  • LUMBAR ARTERY

2

3

4

5

slide44

CONVENTIONAL ANGIOGRAM

1= Common femoral artery

2= Superficial femoral artery

3= Profunda femoral artery (Deep artery of the thigh)

4= Lateral femoral circumflex artery

CALCIFICATION outlines superficial

femoral artery.

1

4

3

2

slide45

ARTERIAL

CALCIFICATION

slide46

LOWER EXTREMITY ARTERIOGRAM

1

2

1

2

3

3

  • COMMON FEMORAL ARTERY
  • PROFUNDA FEMORIS ARTERY (Deep artery of the thigh)
  • SUPERFICIAL FEMORAL ARTERY
slide47

LOWER EXTREMITY ARTERIOGRAM

POPLITEAL ARTERY

4

Subtraction image

slide48

LOWER EXTREMITY ARTERIOGRAM

  • 4. POPLITEAL ARTERY
  • ANTERIOR TIBIAL ARTERY
  • POSTERIOR TIBIAL ARTERY
  • 7. FIBULAR ARTERY

4

5

6

7

slide51

INFERIOR

VENA CAVAGRAM

slide52

LEFT LOWER LEG VENOGRAM

4

2

  • POPLITEAL VEIN
  • FEMORAL VEIN
  • PROFUNDA FEMORAL VEIN
  • GREAT SAPHENOUS VEIN

3

4

2

1

slide53

VENOGRAM

AP projection

Popliteal vein

Calf veins

slide54

CALF VEIN THROMBUS

PULMONARY

EMBOLUS

slide55

Summary

Hip Trauma

Knee Degeneration

Ankle Vascular Injury

Foot Sports Injury