LOWER EXTREMITY

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LOWER EXTREMITY
Francis Neuffer, MD USC SOM Gross Anatomy /
Radiology
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OUTLINE

• Hip Trauma
• Knee Degeneration
• Ankle Vascular
• Foot Sports

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FEMORAL HEAD
ACETABULUM
FEMORAL NECK
AP HIP
GREATER TROCHANTER
FOVEA CAPITIS
LESSER TROCHANTER
CORTICAL BONE
MEDULLARY BONE
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RT. HIP
Pediatric
Adult
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CORONAL MRI
RT. HIP
Epiphyseal Plate
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INTERTROCHANTERIC FRACTURE
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BONE DENSITY MEASUREMENT NUCLEAR MEDICINE
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POST OPERATIVE REPAIR
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ACETABULAR FRACTURE Dashboard fracture
CT SCAN OF THE PELVIS SHOWS FRACTURE
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AVASCULAR NECROSIS
Bone scan
X-ray
MRI
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FRACTURED LT. FEMUR
LAT
AP
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DESCRIBE THE FRACTURE
AP

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

LAT
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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.
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DISTAL FEMUR KNEE
Medial epicondyle
Lateral epicondyle
Lateral tibial condyle
Intercondylar eminence
Medial tibial condyle
Head of fibula
Tibial tuberosity
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KNEE
LATERAL
AP
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MRI RIGHT KNEE
coronal section
anterior
Scan level
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-
MEDIAL
Sagittal sections
MEDIAL MENISCI
PCL
LATERAL MENISCI
ACL
PATELLA TENDON
LATERAL
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SAGITAL MR KNEE (MID JOINT)
QUADRICEPS TENDON
POSTERIOR CRUCIATE LIGAMENT
Scan level
PATELLA
ANTERIOR CRUCIATE LIGAMENT
PATELLAR TENDON
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PATELLA FRACTURE
NORMAL
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TENDON RUPTURE Which One?
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PATELLA TENDON RUPTURE
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NORMAL
QUADRACEPS TENDON INJURY
PATELLA TENDON INJURY
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ANTERIOR CRUCIATE LIGAMENT INJURY
Normal
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POST OPERATIVE LIGAMENT REPAIR
Stabilization of ligament by surgical graft and
screws
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POSTERIOR CRUCIATE LIGAMENT INJURY
Normal
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MENISCUS
NORMAL
TORN
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WHAT IS MY AGE?
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POST OP KNEE REPLACEMENT
Degenerative arthritis
POST-OP
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LOWER LEG
TIBIAL TUBEROSITY
HEAD OF FIBULA
FIBULA
TIBIA
FIBULA
LATERAL MALLEOLUS
MEDIAL MALLEOLUS
AP
LATERAL
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Tibial fracture shows spiral orientation
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AP ANKLE
Tibial shaft
Fibular shaft
Medial malleolus of the tibia
Lateral malleolus of the fibula
Talus
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LATERAL ANKLE
tibia
fibula
talus
navicular
cuboid
calcaneus
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FRACTURES THROUGH THE MEDIAL AND LATERAL
MALLEOLI.
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THIS CT SCAN SHOWS FRACTURES THROUGH THE MEDIAL
AND LATERAL MALEOLI.
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SALTER INJURY TO GROWTH PLATE
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AP 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
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LATERAL FOOT
(NAVICULAR)
(3) CUNEIFORMS
TALUS
METATARSALS
PHALANGES
SUSTENTACULUM TALI
CALCANEUS
CUBOID
SESAMOID BONE
CALCANEAL TUBEROSITY
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CALCANEAL FRACTURE
PATIENT FELL OFF OF A LADDER
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Worse than a 4 wheeler!
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DIABETIC OSTEOMYLITIS
Note air in soft tissues on right due to
bacterial growth.
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BONE SCAN OSTEOMYELITIS
Increased activity on bone scan supports
osteomylitis in metatarsal
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OSTEOMYELITIS OF THE CALCANEUS
normal
Bone destruction
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GOUT
Urate crystal deposits cause inflammation and
erosion.
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SAFETY AND SIDE EFFECTS

• Liver problems
• Nausea
• Gout flairs
• Joint Pain
• Rash
• A small amount of heart attacks, strokes, and
  heart related
• deaths have been reported in patients using this
  medication.

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VASCULAR STRUCTURES
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AP PELVIC ARTERIOGRAM
1
6

1. ABDOMINAL AORTA
2. COMMON ILIAC ARTERY
3. INTERNAL ILIAC ARTERY
4. EXTERNAL ILIAC ARTERY
5. COMMON FEMORAL ARTERY
6. LUMBAR ARTERY

2
3
4
5
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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.
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4
2
3
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ARTERIAL CALCIFICATION
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LOWER EXTREMITY ARTERIOGRAM
1
1
2
2
3
3

1. COMMON FEMORAL ARTERY
2. PROFUNDA FEMORIS ARTERY (Deep artery of the
   thigh)
3. SUPERFICIAL FEMORAL ARTERY

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LOWER EXTREMITY ARTERIOGRAM
POPLITEAL ARTERY
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Subtraction image
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• 4. POPLITEAL ARTERY
• ANTERIOR TIBIAL ARTERY
• POSTERIOR TIBIAL ARTERY
• 7. FIBULAR ARTERY

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5
6
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LOWER EXTREMITY ARTERIOGRAM
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SUPERFICIAL FEMORAL ARTERY ARTERIOGRAM
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BALLOON ANGIOPLASTY OF SFA
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INFERIOR VENA CAVAGRAM
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LEFT LOWER LEG VENOGRAM
4
2

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

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4
2
1
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VENOGRAM AP projection
Popliteal vein
Calf veins
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CALF VEIN THROMBUS
PULMONARY EMBOLUS
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Summary

• Hip Trauma
• Knee Degeneration
• Ankle Vascular Injury
• Foot Sports Injury

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AORTIC ARCH
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CAROTID ARTERIOGRAM
AP Subtraction method
LATERAL
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LIMA GRAFT CLIPS
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CORONARY ARTERIOGRAM