Brooke Miller Radiology

1. Brooke Miller Radiology

2. Hip Trauma Knee Degeneration Ankle Vascular Injury Sports Injury

3. Vastus lateralis attaches to greater trochanter; the obturator internus, superior and inferior gamelli attach to the medial surface of the greater trochanter, Guteus medius to the lateral surface of the greater trochanter, and gluteus minimus to anterior surface of greater trochanter. Iliopsoas attaches to lesser trochanter Pectineus attaches just distal to the lesser trochanterVastus lateralis attaches to greater trochanter; the obturator internus, superior and inferior gamelli attach to the medial surface of the greater trochanter, Guteus medius to the lateral surface of the greater trochanter, and gluteus minimus to anterior surface of greater trochanter. Iliopsoas attaches to lesser trochanter Pectineus attaches just distal to the lesser trochanter

4. Note epiphyseal growth plate at femoral head and greater trochanter on MRINote epiphyseal growth plate at femoral head and greater trochanter on MRI

6. This is showing the repair done here. This is an IM rod that they drill and hammer into your bone to fix the fracture.This is showing the repair done here. This is an IM rod that they drill and hammer into your bone to fix the fracture.

8. Avascular Necrosis or AVN is caused by the loss of blood supply to a bone. It can happen anywhere but the most common place is in long bones such as the femur. It can be the result of a number of different things including injury or long term use of steriods. In this case it is the loss of blood supply to the femoral head from the artery to the head of the femur which comes from the posterior division of the obturator artery. Loss of blood supply to the femoral head can lead to collapse, fragmentation and arthritisAvascular Necrosis or AVN is caused by the loss of blood supply to a bone. It can happen anywhere but the most common place is in long bones such as the femur. It can be the result of a number of different things including injury or long term use of steriods. In this case it is the loss of blood supply to the femoral head from the artery to the head of the femur which comes from the posterior division of the obturator artery. Loss of blood supply to the femoral head can lead to collapse, fragmentation and arthritis

9. Mineral density is compared to young normal patients to assess for osteoporosisMineral density is compared to young normal patients to assess for osteoporosis

10. The angle of inclination is between the long axis of the femoral neck and the femoral shaft and it varies with age, sex, and development of the femor. The angle of inclination in a three year old child is 45 in an adult it is 126 and in an elderly individual the angle of inclination is 120. The angle is less in females because of the increased width between the acetabula and the greater obliquity of the shaft. The angle of inclination allows greater mobility of the femur at the hip joint because it places the head and neck more perpendicular to the acetabulum in the neutral postion. When the angle is decreased the condition is known as coxa vara (angle is less than 120) and when it is increased it is known as coxa valga (usually greater than 135). Coxa vara causes a mild shortening of the lower limb and limits passive abduction of the hip. The angle of inclination is between the long axis of the femoral neck and the femoral shaft and it varies with age, sex, and development of the femor. The angle of inclination in a three year old child is 45 in an adult it is 126 and in an elderly individual the angle of inclination is 120. The angle is less in females because of the increased width between the acetabula and the greater obliquity of the shaft. The angle of inclination allows greater mobility of the femur at the hip joint because it places the head and neck more perpendicular to the acetabulum in the neutral postion. When the angle is decreased the condition is known as coxa vara (angle is less than 120) and when it is increased it is known as coxa valga (usually greater than 135). Coxa vara causes a mild shortening of the lower limb and limits passive abduction of the hip.

11. RF= Rectus Femoris VI= Vastus intermedius VL= Vastus Lateralis VM= Vastus Medialis FA= Femoral Artery FV= Femoral Vein S= Sartorius G= Gracilis SM= Semimembranosus ST= Semitendinosus GSV= Greater Saphenous Vein BFS= Biceps femoris short head BFL= Biceps femoris long head AM= Adductor Magnus SN= Siatic NerveRF= Rectus Femoris VI= Vastus intermedius VL= Vastus Lateralis VM= Vastus Medialis FA= Femoral Artery FV= Femoral Vein S= Sartorius G= Gracilis SM= Semimembranosus ST= Semitendinosus GSV= Greater Saphenous Vein BFS= Biceps femoris short head BFL= Biceps femoris long head AM= Adductor Magnus SN= Siatic Nerve

17. Abdominal aorta branches into the two common iliac arteries. The iliac artery gives an external and internal illiac arteries. The femoral artery is a continuation of the external illiac artery distal to the inguinal ligament.Abdominal aorta branches into the two common iliac arteries. The iliac artery gives an external and internal illiac arteries. The femoral artery is a continuation of the external illiac artery distal to the inguinal ligament.

18. Calcification outlines Superficial Femoral artery The common femoral artery gives the superficial femoral artery branch and the profunda femoral artery or deep artery of the thigh branch. The lateral femoral circumflex artery comes off the deep artery of the thigh or it may arise from the femoral artery.Calcification outlines Superficial Femoral artery The common femoral artery gives the superficial femoral artery branch and the profunda femoral artery or deep artery of the thigh branch. The lateral femoral circumflex artery comes off the deep artery of the thigh or it may arise from the femoral artery.

20. What is it called when you remove the bones from the picture?What is it called when you remove the bones from the picture?

21. The popliteal artery is a continuation of the femoral artery. The popliteal artery becomes the popliteal artery at the adductor hiatus in adductor magnus. The anterior tibial and the posterior tibial arteries are branches off of your popliteal artery. The fibular artery is a branch from you posterior tibial artery. The popliteal artery is a continuation of the femoral artery. The popliteal artery becomes the popliteal artery at the adductor hiatus in adductor magnus. The anterior tibial and the posterior tibial arteries are branches off of your popliteal artery. The fibular artery is a branch from you posterior tibial artery.

22. Stenosis on the superficial femoral artery ateriogram.Stenosis on the superficial femoral artery ateriogram.

23. Diagram of angioplasty balloon catheter. The balloon is inflated at the vessel stenosis to open vessel. This goes down through the femoral artery to the superficial femoral arteryDiagram of angioplasty balloon catheter. The balloon is inflated at the vessel stenosis to open vessel. This goes down through the femoral artery to the superficial femoral artery

24. Occluded superficial arteries fill by collateral vessels from the profunda circulation Stenosis has progressed to occlusion. claudicationOccluded superficial arteries fill by collateral vessels from the profunda circulation Stenosis has progressed to occlusion. claudication

25. Popliteal artery in picture 1 Deep artery of the thigh and the superficial femoral artery in picture 2 Popliteal artery in picture 1 Deep artery of the thigh and the superficial femoral artery in picture 2

26. The great saphenous vein is formed by the dorsal vein of the great toe and the dorsal venous arch. The great saphenous vein anastomoses freely with the small saphenous vein on the posterior aspect of the calf and then empties in the femoral vein. Remember that the small saphenous vein empties into the popliteal vein in the popliteal fossa which then empties into the femoral vein. (it ascends between the heads of the gastrocnemius muscle) All three deep veins from the leg flow into the popliteal vein posterior to the knee which becomes the femoral vein in the thigh. The great saphenous vein is formed by the dorsal vein of the great toe and the dorsal venous arch. The great saphenous vein anastomoses freely with the small saphenous vein on the posterior aspect of the calf and then empties in the femoral vein. Remember that the small saphenous vein empties into the popliteal vein in the popliteal fossa which then empties into the femoral vein. (it ascends between the heads of the gastrocnemius muscle) All three deep veins from the leg flow into the popliteal vein posterior to the knee which becomes the femoral vein in the thigh.

28.  This is important because these calf vein thrombi can travel up and cause a pulmonary embolus.This is important because these calf vein thrombi can travel up and cause a pulmonary embolus.

29. Is this patella in the correct place? What would it look like if your patellar ligament was ruptured?Is this patella in the correct place? What would it look like if your patellar ligament was ruptured?

30. You can see how far superior the patella is being pulled by the quadraceps muscle. I will show you this again later with an MRI.You can see how far superior the patella is being pulled by the quadraceps muscle. I will show you this again later with an MRI.

32. - Saggittal images show menisci, cruciate ligaments and patella ligamentsSaggittal images show menisci, cruciate ligaments and patella ligaments

33. Quadriceps tendon, patella, patellar tendon , anterior cruciate ligament , posterior Cruciate ligamentQuadriceps tendon, patella, patellar tendon , anterior cruciate ligament , posterior Cruciate ligament

34. Patella fracturePatella fracture

36. A test to see if this is still intact is the anterior draw sign where you pull the tibia anterior to the femur. If the ACL is ruptured there will be nothing to prevent the tibia from coming really far forward and you will not feel an end feel.A test to see if this is still intact is the anterior draw sign where you pull the tibia anterior to the femur. If the ACL is ruptured there will be nothing to prevent the tibia from coming really far forward and you will not feel an end feel.

37. They take a piece of you� and drill it in with these screwsThey take a piece of you� and drill it in with these screws

38. Posterior draw sign. Push the tibia posterior to the relative to the femur and if it is ruptured there will be no end feel and the tibia will go really far posteriorPosterior draw sign. Push the tibia posterior to the relative to the femur and if it is ruptured there will be no end feel and the tibia will go really far posterior

41. Post op total knee.Post op total knee.

45. Fractures through the medial and lateral malleoliFractures through the medial and lateral malleoli

46. This is a CT scan showing you the fractures through the medial and lateral maleoli CT scans with sagittal reconstructions and 3-D volumn imagingThis is a CT scan showing you the fractures through the medial and lateral maleoli CT scans with sagittal reconstructions and 3-D volumn imaging

51. Note air in soft tissues on right due to bacterial growth.Note air in soft tissues on right due to bacterial growth.

52. Increased activity on bone scan supports osteomylitis in metatarsalIncreased activity on bone scan supports osteomylitis in metatarsal

53. Urate crystals deposit and cause inflamation and erosion.Urate crystals deposit and cause inflamation and erosion.