Title: LOWER EXTREMITY
1LOWER EXTREMITY
Francis Neuffer, MD USC SOM Gross Anatomy /
Radiology
2OUTLINE
- Hip Trauma
- Knee Degeneration
- Ankle Vascular
- Foot Sports
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
EPIPHYSEAL PLATE
6INTERTROCHANTERIC FRACTURE
7BONE DENSITY MEASUREMENT NUCLEAR MEDICINE
8POST OPERATIVE REPAIR
9TOTAL HIP REPLACEMENT
ARTHRITIC HIP
NORMAL
10DASHBOARD HIP INJURY
11ACETABULAR FRACTURE Dashboard fracture
CT SCAN OF THE PELVIS SHOWS FRACTURE
12AVASCULAR NECROSIS
Bone scan
X-ray
MRI
13FRACTURED LT. FEMUR
LAT
AP
14DESCRIBE THE FRACTURE
AP
- BONE AND WHICH PART
- FRACTURE ORIENTATION AND PARTS
- DISPLACEMENT AND ANGULATION
- JOINT / SOFT TISSUE INVOLVEMENT
LAT
15EXAMPLE
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.
16AP RT KNEE
Medial epicondyle
Lateral epicondyle
Lateral tibial condyle
Intercondylar eminence
Medial tibial condyle
Head of fibula
Tibial tuberosity
17KNEE
LATERAL
AP
18MRI RIGHT KNEE
coronal section
anterior
Scan level
19-
MEDIAL
Sagittal sections
MEDIAL MENISCI
PCL
LATERAL MENISCI
ACL
PATELLA TENDON
LATERAL
20SAGITAL MR KNEE (MID JOINT)
QUADRICEPS TENDON
POSTERIOR CRUCIATE LIGAMENT
Scan level
PATELLA
ANTERIOR CRUCIATE LIGAMENT
PATELLAR TENDON
21PATELLA FRACTURE
NORMAL
22TENDON RUPTURE Which One?
23PATELLA TENDON RUPTURE
24NORMAL
QUADRACEPS TENDON INJURY
PATELLA TENDON INJURY
25ANTERIOR CRUCIATE LIGAMENT INJURY
Normal
26POST OPERATIVE LIGAMENT REPAIR
Stabilization of ligament by surgical graft and
screws
27POSTERIOR CRUCIATE LIGAMENT INJURY
Normal
28MENISCUS
NORMAL
TORN
29WHAT IS MY AGE?
30POST OP KNEE REPLACEMENT
DEGENERATIVE ARTHRITIS
POST-OP
31LOWER LEG
TIBIAL TUBEROSITY
HEAD OF FIBULA
FIBULA
TIBIA
FIBULA
LATERAL MALLEOLUS
MEDIAL MALLEOLUS
LATERAL
AP
32TIBIAL FRACTURE SHOWS SPIRAL ORIENTATION
33AP ANKLE
Tibial shaft
Fibular shaft
Medial malleolus of the tibia
Lateral malleolus of the fibula
Talus
34LATERAL ANKLE
tibia
fibula
talus
navicular
cuboid
calcaneus
35FRACTURES THROUGH THE MEDIAL AND LATERAL
MALLEOLI.
36THIS CT SCAN SHOWS FRACTURES THROUGH THE MEDIAL
AND LATERAL MALEOLI.
37SALTER INJURY TO GROWTH PLATE
38AP 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
39LATERAL FOOT
(NAVICULAR)
(3) CUNEIFORMS
TALUS
METATARSALS
PHALANGES
SUSTENTACULUM TALI
CALCANEUS
CUBOID
SESAMOID BONE
CALCANEAL TUBEROSITY
40CALCANEAL FRACTURE
PATIENT FELL OFF OF A LADDER
41WORSE THAN A 4 WHEELER!
42DIABETIC OSTEOMYLITIS
Note air in soft tissues on right due to
bacterial growth.
43BONE SCAN OSTEOMYELITIS
Increased activity on bone scan supports
osteomyelitis in metatarsal
44 OSTEOMYELITIS OF THE CALCANEUS
normal
Bone destruction
45GOUT
Urate crystal deposits cause inflammation and
erosion.
46VASCULAR STRUCTURES
47AP PELVIC ARTERIOGRAM
1
6
- ABDOMINAL AORTA
- COMMON ILIAC ARTERY
- INTERNAL ILIAC ARTERY
- EXTERNAL ILIAC ARTERY
- COMMON FEMORAL ARTERY
- LUMBAR ARTERY
2
3
4
5
48CONVENTIONAL 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
49ARTERIAL CALCIFICATION
50LOWER EXTREMITY ARTERIOGRAM
1
1
2
2
3
3
- COMMON FEMORAL ARTERY
- PROFUNDA FEMORIS ARTERY (Deep artery of the
thigh) - SUPERFICIAL FEMORAL ARTERY
51LOWER EXTREMITY ARTERIOGRAM
POPLITEAL ARTERY
4
Subtraction image
52- 4. POPLITEAL ARTERY
- ANTERIOR TIBIAL ARTERY
- POSTERIOR TIBIAL ARTERY
- 7. FIBULAR ARTERY
4
5
6
7
LOWER EXTREMITY ARTERIOGRAM
53SUPERFICIAL FEMORAL ARTERY ARTERIOGRAM
54BALLOON ANGIOPLASTY OF SFA
55INFERIOR VENA CAVAGRAM
56LEFT LOWER LEG VENOGRAM
4
2
- POPLITEAL VEIN
- FEMORAL VEIN
- PROFUNDA FEMORAL VEIN
- GREAT SAPHENOUS VEIN
3
4
2
1
57VENOGRAM AP projection
Popliteal vein
Calf veins
58CALF VEIN THROMBUS
PULMONARY EMBOLUS
59Summary
- Hip Trauma
- Knee Degeneration
- Ankle Vascular Injury
- Foot Sports Injury
60Happy Thanksgiving!