Title: LOWER EXTREMITY
1LOWER EXTREMITY
Francis Neuffer, MD USC SOM Gross Anatomy /
Radiology
2OUTLINE
- Hip Trauma
- Knee Degeneration
- Ankle Vascular Injury
- Foot Sports Injury
3FEMORAL HEAD
ACETABULUM
FEMORAL NECK
AP HIP
GREATER TROCHANTER
FOVEA CAPITIS
LESSER TROCHANTER
CORTICAL BONE
MEDULLARY BONE
4RT. HIP
Pediatric
Adult
5CORONAL MRI
RT. HIP
6INTERTROCHANTERIC FRACTURE
7BONE DENSITY MEASUREMENT NUCLEAR MEDICINE
8POST OPERATIVE REPAIR
9ACETABULAR FRACTURE Dashboard fracture
CT SCAN OF THE PELVIS SHOWS FRACTURE
10AVASCULAR NECROSIS
Bone scan
X-ray
MRI
11FRACTURED LT. FEMUR
LAT
AP
12DESCRIBE THE FRACTURE
AP
- BONE AND WHICH PART
- FRACTURE ORIENTATION AND PARTS
- DISPLACEMENT AND ANGULATION
- JOINT / SOFT TISSUE INVOLVEMENT
LAT
13EXAMPLE
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.
14DISTAL FEMUR KNEE
Medial epicondyle
Lateral epicondyle
Lateral tibial condyle
Intercondylar eminence
Medial tibial condyle
Head of fibula
Tibial tuberosity
15KNEE
LATERAL
AP
16Tendon Rupture Which One?
17MRI RIGHT KNEE
coronal section
anterior
Scan level
18-
MEDIAL
Sagittal sections
MEDIAL MENISCI
PCL
LATERAL MENISCI
ACL
PATELLA TENDON
LATERAL
19SAGITAL MR KNEE (MID JOINT)
QUADRICEPS TENDON
POSTERIOR CRUCIATE LIGAMENT
Scan level
PATELLA
ANTERIOR CRUCIATE LIGAMENT
PATELLAR TENDON
20PATELLA FRACTURE
NORMAL
21NORMAL
QUADRACEPS TENDON INJURY
PATELLA TENDON INJURY
22PATELLA TENDON RUPTURE
23ANTERIOR CRUCIATE LIGAMENT INJURY
Normal
24POST OPERATIVE LIGAMENT REPAIR
Stabilization of ligament by surgical graft and
screws
25POSTERIOR CRUCIATE LIGAMENT INJURY
Normal
26MENISCUS
NORMAL
TORN
27WHAT IS MY AGE?
28POST OP KNEE REPLACEMENT
Degenerative arthritis
POST-OP
29LOWER LEG
TIBIAL TUBEROSITY
HEAD OF FIBULA
FIBULA
TIBIA
FIBULA
LATERAL MALLEOLUS
MEDIAL MALLEOLUS
AP
LATERAL
30Tibial fracture shows spiral orientation
31AP ANKLE
Tibial shaft
Fibular shaft
Medial malleolus of the tibia
Lateral malleolus of the fibula
Talus
32LATERAL ANKLE
tibia
fibula
talus
navicular
cuboid
calcaneus
33FRACTURES THROUGH THE MEDIAL AND LATERAL
MALLEOLI.
34THIS CT SCAN SHOWS FRACTURES THROUGH THE MEDIAL
AND LATERAL MALEOLI.
35SALTER INJURY TO GROWTH PLATE
36AP FOOT
DIP
PIP
DISTAL PHALANX MIDDLE PHALANX PROXIMAL PHALANX
PHALANGES
MTP
CUNIFORMS
3RD
SESAMOID BONES
METATARSALS
1ST
2ND
I
II
III
IV
V
SCAPHOID
CUBOID
TALUS
TARSALS
CALCANEUS
37LATERAL FOOT
(NAVICULAR)
(3) CUNEIFORMS
TALUS
METATARSALS
PHALANGES
SUSTENTACULUM TALI
CALCANEUS
CUBOID
SESAMOID BONE
CALCANEAL TUBEROSITY
38CALCANEAL FRACTURE
PATIENT FELL OFF OF A LADDER
39DIABETIC OSTEOMYLITIS
Note air in soft tissues on right due to
bacterial growth.
40BONE SCAN OSTEOMYELITIS
Increased activity on bone scan supports
osteomylitis in metatarsal
41GOUT
Urate crystal deposits cause inflammation and
erosion.
42VASCULAR STRUCTURES
43AP PELVIC ARTERIOGRAM
1
6
- ABDOMINAL AORTA
- COMMON ILLIAC ARTERY
- INTERNAL ILLIAC ARTERY
- EXTERNAL ILLIAC ARTERY
- COMMON FEMORAL ARTERY
- LUMBAR ARTERY
2
3
4
5
44CONVENTIONAL 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
2
3
45ARTERIAL CALCIFICATION
46LOWER EXTREMITY ARTERIOGRAM
1
1
2
2
3
3
- COMMON FEMORAL ARTERY
- PROFUNDA FEMORIS ARTERY (Deep artery of the
thigh) - SUPERFICIAL FEMORAL ARTERY
47LOWER EXTREMITY ARTERIOGRAM
POPLITEAL ARTERY
4
Subtraction image
48LOWER EXTREMITY ARTERIOGRAM
- 4. POPLITEAL ARTERY
- ANTERIOR TIBIAL ARTERY
- POSTERIOR TIBIAL ARTERY
- 7. FIBULAR ARTERY
4
5
6
7
49SUPERFICIAL FEMORAL ARTERY ARTERIOGRAM
50BALLOON ANGIOPLASTY OF SFA
51INFERIOR VENA CAVAGRAM
52LEFT LOWER LEG VENOGRAM
4
2
- POPLITEAL VEIN
- FEMORAL VEIN
- PROFUNDA FEMORAL VEIN
- GREAT SAPHENOUS VEIN
3
4
2
1
53VENOGRAM AP projection
Popliteal vein
Calf veins
54CALF VEIN THROMBUS
PULMONARY EMBOLUS
55Summary
- Hip Trauma
- Knee Degeneration
- Ankle Vascular Injury
- Foot Sports Injury
56(No Transcript)