What lies deep to the skin?
Subcutaneous tissue (superficial fascia).
p.41
Motor Innervation of Lower Limb
What is the stand-easy position?
A position where the hip and knee joints are extended and in their most stable positions.
What is the common misconception about the term 'hip fracture'?
It is often incorrectly applied to fractures of the femoral head, neck, or trochanters.
p.38
Lymphatic Drainage of the lower limb
What should be examined when inguinal lymph nodes are enlarged?
The entire field of drainage, including the trunk inferior to the umbilicus and the entire lower limb.
Which bones articulate at the subtalar joint?
The talus and the calcaneus.
p.27
venous Drainage of the lower limb
What is the function of multiple perforating veins?
To shunt blood from the superficial veins to the deep veins.
p.33
cutaneous innervation of lower limb
Which dermatome map is preferred by many clinicians?
The map according to Foerster (1933) due to its correlation with clinical findings.
What is intraosseous (IO) infusion?
A method of delivering hydration, blood, and medications directly into the medullary cavity of a bone.
What is the function of the hip bones when standing?
To receive half the weight of the upper body.
p.25
deep fascia of the leg
What do the anterior and posterior intermuscular septa attach to?
The corresponding margins of the fibula.
p.25
deep fascia of the leg
How many compartments does the leg have?
Three compartments: anterior, lateral, and posterior.
What activity may lead to a diagonal fracture of the tibial shaft?
Severe torsion during skiing.
How far from the tibial tuberosity should the needle be inserted for IO infusion?
Approximately 2 cm distal and slightly medial.
p.25
venous Drainage of the lower limb
Where are the superficial veins located in the lower limb?
In the subcutaneous tissue.
p.38
Motor Innervation of Lower Limb
What symptoms may occur if the saphenous nerve is affected during a nerve block?
Paresthesia, including tingling, burning, or tickling radiating to the knee and medial side of the leg.
p.40
cutaneous innervation of lower limb
What nerves supply the leg and dorsum of the foot?
Saphenous, sural, and fibular nerves.
What typically causes metatarsal fractures?
When a heavy object falls on the foot.
p.27
venous Drainage of the lower limb
What do the deep veins usually occur as?
Duplicate or multiple accompanying veins.
p.14
Motor Innervation of Lower Limb
Why is awareness of the nutrient foramen location in the fibula important?
It is crucial for performing free vascularized fibular transfers.
p.27
Lymphatic Drainage of the lower limb
Where do the superficial lymphatic vessels converge?
Toward and accompany the great saphenous vein.
p.27
Lymphatic Drainage of the lower limb
Into which lymph nodes do the superficial lymphatic vessels drain?
The inferior (vertical) group of superficial inguinal lymph nodes.
p.14
Motor Innervation of Lower Limb
Why is the anterior tibia accessible for bone grafting in children?
Due to its extensive subcutaneous location.
Where do avulsion fractures typically occur?
At apophyses, where muscles or ligaments are attached.
p.34
Motor Innervation of Lower Limb
How do lower limb muscles typically receive motor fibers?
From several spinal cord segments or nerves.
What is a 'boot-top fracture'?
A fracture resulting from a high-speed forward fall while skiing, angling the leg over the rigid ski boot.
What is a common cause of metatarsal fractures in dancers?
Losing balance and putting full body weight on the metatarsal.
p.43
Motor Innervation of Lower Limb
What is demonstrated in relaxed standing regarding the line of gravity?
The relationship of the line of gravity to the transverse rotational axes of the pelvis and lower limb.
p.25
venous Drainage of the lower limb
What are the two major superficial veins in the lower limb?
The great and small saphenous veins.
What is an avulsion fracture of the 5th metatarsal commonly associated with?
Pain and edema at the base of the 5th metatarsal, and may be associated with a severe ankle sprain.
p.43
Motor Innervation of Lower Limb
Where does the center of gravity fall during relaxed standing?
In the posterior third of a median plane between the slightly parted and laterally rotated feet.
How does the subcutaneous tissue change at the knee?
It loses its fat and blends with the deep fascia.
What causes fibular fractures during a slip?
The foot is forced into an excessively inverted position, tearing ankle ligaments.
What age group is most affected by dislocated epiphysis of the femoral head?
Older children and adolescents (10–17 years of age).
p.31
cutaneous innervation of lower limb
What are the branches of the lumbar and sacral plexuses responsible for?
Supplying cutaneous nerves to the lower limb.
What types of trauma can lead to dislocated epiphysis of the femoral head?
Acute trauma or repetitive microtraumas.
p.14
Motor Innervation of Lower Limb
What is the significance of the nutrient foramen for grafting?
It allows for blood supply to the medullary cavity and compact bone.
p.27
venous Drainage of the lower limb
Where does the great saphenous vein pass in relation to the medial malleolus?
Anterior to the medial malleolus.
When is IO infusion primarily used?
In cases of traumatic shock and in children with circulatory collapse.
p.28
venous Drainage of the lower limb
What vein accompanies the small saphenous vein in the posterolateral leg?
The great saphenous vein.
p.28
Lymphatic Drainage of the lower limb
What nodes do the efferent vessels from the popliteal lymph nodes join?
Deep inguinal lymph nodes.
p.40
Lymphatic Drainage of the lower limb
What nodes does lymph drainage from the lower limb pass to after the inguinal nodes?
External and common iliac nodes of the trunk.
p.30
venous Drainage of the lower limb
What veins form the posterior tibial and fibular veins?
Medial and lateral plantar veins.
p.21
clinical box of the bone of lower limb
What role does the angle of inclination play in the femur?
It allows increased leverage and superior placement of the abductors.
What is the iliotibial tract?
A broad band of fibers that is the shared aponeurosis of the tensor fasciae latae and gluteus maximus muscles.
What is the most common type of lower limb injuries?
Knee, leg, and foot injuries.
What are intracapsular fractures?
Fractures occurring within the hip joint capsule.
p.35
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What is a common sign of arterial compression in the lower limb?
Loss of distal leg pulses.
p.39
cutaneous innervation of lower limb
What does a peripheral nerve sensitizing an area of skin represent?
More than one segment of the spinal cord.
p.30
Lymphatic Drainage of the lower limb
What do superficial lymphatic vessels accompany?
The saphenous veins and their tributaries.
What is the function of the sesamoid bones of the great toe?
They bear the weight of the body, especially during the latter part of the stance phase of walking.
Why is a calcaneal fracture usually disabling?
Because it disrupts the subtalar (talocalcaneal) joint.
p.26
venous Drainage of the lower limb
How are the veins of the lower limb categorized?
Into superficial and deep groups.
p.26
venous Drainage of the lower limb
Where do superficial veins course?
Within the subcutaneous tissue.
What movements place increased shearing stress on the epiphysis?
Abduction and lateral rotation of the thigh.
p.14
Motor Innervation of Lower Limb
What is another use of the anterior tibia in children?
It is used as a site for intraosseous infusion in dehydrated children or those in shock.
What happens to the weight distribution during walking?
The hip bones receive all the weight periodically.
What do the thick parts of the hip bone do?
Transfer weight to the femur.
p.34
Motor Innervation of Lower Limb
What can the strength and ability to perform particular movements indicate?
The level of spinal cord injury or nerve impingement.
Why can fibular fractures be painful?
Due to disrupted muscle attachments.
What types of needles are used for IO infusion?
Special needles designed for manual insertion or battery-powered/impact-driven devices.
p.25
venous Drainage of the lower limb
What is the relationship between deep veins and major arteries in the lower limb?
Deep veins accompany all major arteries.
p.36
venous Drainage of the lower limb
What is the result of incompetent valves in varicose veins?
Blood flows inferiorly in the veins.
p.28
venous Drainage of the lower limb
What is formed when tributaries from the medial and posterior aspects of the thigh unite?
An accessory saphenous vein.
p.30
venous Drainage of the lower limb
What happens to blood flow when a person stands quietly?
Blood flow is slower due to gravity.
p.36
venous Drainage of the lower limb
What can cause venous stasis?
Incompetent, loose fascia that fails to resist muscle expansion.
p.35
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What structures are particularly vulnerable to compression in compartment syndromes?
Small vessels of muscles and nerves (vasa nervorum).
What is a comminuted fracture?
A fracture where the bone is broken into several pieces.
p.31
cutaneous innervation of lower limb
What supplies the skin of the lower limb?
Cutaneous nerves in the subcutaneous tissue.
p.34
cutaneous innervation of lower limb
What do the cutaneous nerves of the lower limb convey?
Sensory fibers to the cutaneous nerves.
p.38
Motor Innervation of Lower Limb
What may happen if the saphenous nerve is cut during a saphenous cutdown?
The patient may complain of pain or numbness along the medial border of the foot.
p.38
Lymphatic Drainage of the lower limb
What causes enlargement of the superficial inguinal lymph nodes?
Abrasions and minor sepsis caused by pathogenic microorganisms or their toxins.
p.34
Motor Innervation of Lower Limb
What are myotomes related to?
Segmental innervation of muscle groups and movements of the lower limb.
p.38
Motor Innervation of Lower Limb
Where can the femoral nerve be blocked?
2 cm inferior to the inguinal ligament, approximately a finger’s breadth lateral to the femoral artery.
What does the fascia lata enclose?
The large thigh muscles, especially laterally.
p.35
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What can cause increased intracompartmental pressure in the lower limb?
Trauma, burns, intense muscle use, or blunt trauma.
What happens to the 5th metatarsal during sudden inversion of the foot?
The tuberosity may be avulsed by the tendon of the fibularis brevis muscle.
p.44
Motor Innervation of Lower Limb
What simplification is made in the description of the gait cycle?
Two phases have been combined for simplification.
What do the fascial compartments of the thigh and leg contain?
Muscles sharing common functions and innervation.
p.21
clinical box of the bone of lower limb
How do the tibia and fibula contribute to locomotion?
They have become permanently pronated to provide a stable stance.
What forms the walls of the thigh muscle compartments?
The fascia lata and three fascial intermuscular septa.
What happens to the blood supply of the bone after a fibular graft is secured?
It restores the blood supply to the bone to which it is attached.
p.29
venous Drainage of the lower limb
What is the path of the small saphenous vein?
It ascends posterior to the lateral malleolus, along the lateral border of the calcaneal tendon, and penetrates the deep fascia.
What may happen to the body of the talus in severe cases of talar neck fractures?
It may dislocate posteriorly.
p.26
venous Drainage of the lower limb
Where are deep veins located?
Internal to the deep fascia.
p.27
venous Drainage of the lower limb
How far posterior to the patella does the great saphenous vein pass?
Approximately a hand’s breadth.
What does the term 'valga' or 'valgus' indicate?
A bone or joint that deviates away from the midline.
What effect does coxa vara have on the lower limb?
Causes mild shortening and limits passive abduction of the hip.
What is the purpose of the thin parts of the hip bone?
Provide a broad surface for attachment.
p.38
Motor Innervation of Lower Limb
How can a nerve block be achieved in the lower limbs?
By making perineural injections of anesthetics close to the nerves.
p.40
cutaneous innervation of lower limb
What reflects the cutaneous innervation of the lower limb?
The original segmental innervation of the skin via separate spinal nerves and plexus formation.
How does age affect the vulnerability of the femur to fractures?
It becomes increasingly vulnerable with age, especially in females due to osteoporosis.
p.44
Motor Innervation of Lower Limb
What is the gait cycle?
The activity of one limb between two repeated events of walking.
p.35
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What happens when intracompartmental pressure increases?
It can compress small vessels and nerves, leading to ischemia and potential permanent injury.
Can normal activities like walking and running continue after a segment of the fibula is removed?
Yes, they can be normal even after removal.
What is impaction in the context of femoral fractures?
Overriding of fragments resulting in foreshortening of the limb.
p.21
clinical box of the bone of lower limb
What is the function of the bones of the foot?
They allow weight distribution, maintain balance, and perform shock absorption.
p.29
venous Drainage of the lower limb
What veins does the great saphenous vein receive at its termination?
Superficial circumflex iliac, superficial epigastric, and external pudendal veins.
p.35
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What is an obvious sign of tissue ischemia due to compression?
Lowering of the temperature of tissues distal to the compression.
p.30
Lymphatic Drainage of the lower limb
Where do deep lymphatic vessels from the leg ascend to?
Deep inguinal lymph nodes.
What can cause fractures of the talar neck?
Severe dorsiflexion of the ankle, such as pressing hard on the brake pedal during a collision.
What happens to the talus during a slip that leads to fibular fractures?
It is forcibly tilted against the lateral malleolus, potentially shearing it off.
p.33
cutaneous innervation of lower limb
What is the significance of dermatomes in the lower limb?
They represent the segmental pattern of distribution of sensory nerve fibers.
What is the angle of inclination between in the context of coxa vara and coxa valga?
Between the long axis of the femoral neck and the femoral shaft.
What happens during an avulsion fracture?
A small part of bone with a piece of a tendon or ligament attached is torn away.
p.34
Motor Innervation of Lower Limb
What type of fibers transmit impulses to the muscles of the lower limb?
Somatic motor (general somatic efferent) fibers.
p.26
venous Drainage of the lower limb
What is shown in the inset of Figure 7.15?
The proximal ends of the femoral and great saphenous veins opened and spread apart.
What type of fracture can occur from indirect violence applied to the tibial shaft?
Fracture when the bone turns with the foot fixed during a fall.
p.38
Lymphatic Drainage of the lower limb
Why should the possibility of metastasis from the uterus be considered in female patients with enlarged inguinal lymph nodes?
Because lymphatic drainage from the uterine fundus may flow to the superficial inguinal lymph nodes.
Why is the neck of the femur particularly vulnerable to fractures?
Because it is the narrowest and weakest part of the bone and lies at an angle to the line of weight bearing.
p.1
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
Where can the cuboid bone be palpated?
On the lateral aspect of the foot, posterior to the base of the 5th metatarsal.
How does a fibular fracture affect walking?
It compromises walking due to the bone's role in ankle stability.
What condition may result from disruption of the epiphysial plate at the tibial tuberosity?
Osgood-Schlatter disease.
p.36
venous Drainage of the lower limb
What are the symptoms of Deep Venous Thrombosis (DVT)?
Swelling, warmth, and erythema.
p.37
venous Drainage of the lower limb
What can cause external pressure on veins during a prolonged hospital stay?
Bedding, tight casts, or bandages.
p.35
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What is a fasciotomy?
An incision of overlying fascia or a septum to relieve pressure in compartments.
p.43
Motor Innervation of Lower Limb
What must be countered periodically to prevent forward sway?
Bilateral contraction of the calf muscles (plantarflexion).
p.36
venous Drainage of the lower limb
What is the role of the musculovenous pump?
To assist in venous return by preventing blood stagnation.
p.35
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What are the consequences of increased pressure in a confined anatomical space?
Adverse effects on circulation and tissue viability, leading to compartment syndromes.
p.1
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What are epiphysial plates?
Discs of hyaline cartilage between the metaphysis and epiphysis of a mature long bone that permit growth.
p.43
Motor Innervation of Lower Limb
What phases are involved in the gait cycle during walking?
Alternating swing and stance phases.
Where is the most frequent site of tibial fractures?
At the junction of the middle and inferior thirds of the tibial shaft.
p.39
venous Drainage of the lower limb
How do deep veins aid venous return?
Through muscle compression (musculovenous pump).
Where do fibular fractures commonly occur?
2–6 cm proximal to the distal end of the lateral malleolus.
p.22
venous Drainage of the lower limb
Which veins are included in the superficial veins of the subcutaneous tissue?
Great and small saphenous veins and their tributaries.
What causes the epiphysis of the femoral head to slip away from the femoral neck?
Weakened epiphysial plate.
p.14
Motor Innervation of Lower Limb
Where is the nutrient foramen typically located in the fibula?
In the middle third of the fibula.
p.33
cutaneous innervation of lower limb
What is the advantage of the Keegan and Garrett (1948) dermatome map?
It is preferred for its aesthetic uniformity and correlation with development.
p.33
cutaneous innervation of lower limb
How do adjacent dermatomes behave in the lower limb?
They overlap considerably, except along the axial line.
What does the term 'vara' or 'varus' indicate?
A bone or joint that deviates toward the midline.
p.34
Motor Innervation of Lower Limb
What is a myotome?
The unilateral embryological muscle mass receiving innervation from a single spinal cord segment or spinal nerve.
p.28
Lymphatic Drainage of the lower limb
Where do the lymphatics from the posterolateral leg initially drain?
Into the popliteal lymph nodes.
p.21
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What is the primary function of the pelvic girdle?
To encircle and protect the pelvic viscera, particularly the reproductive organs.
What types of fractures are common in soccer and basketball players?
Fractures of the lateral and medial malleoli.
p.36
venous Drainage of the lower limb
Where are varicose veins commonly found?
In the posteromedial parts of the lower limb.
p.35
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What are the fascial compartments of the lower limbs?
Generally closed spaces ending at the joints.
At what age does the primary ossification center for the superior end of the tibia typically join the shaft?
During adolescence, usually between 16–18 years of age.
What are two common locations for proximal femur fractures?
Transcervical (middle of neck) and intertrochanteric.
p.21
clinical box of the bone of lower limb
What is the function of the patella?
It provides mechanical advantage in extending the knee.
p.25
venous Drainage of the lower limb
How is the great saphenous vein formed?
By the union of the dorsal vein of the great toe and the dorsal venous arch of the foot.
What complication arises from intracapsular fractures?
Degeneration of the femoral head due to vascular trauma.
What can happen if a large thrombus breaks free from a lower limb vein?
It may travel to the lung, forming a pulmonary thromboembolism.
Which athletes have an increased prevalence of os trigonum?
Soccer players and ballet dancers.
p.39
Motor Innervation of Lower Limb
What is tested to assess pain sensation?
Using a sharp object and asking the patient if pain is felt.
p.30
Lymphatic Drainage of the lower limb
What nodes do lymph from the deep inguinal lymph nodes pass to?
External and common iliac lymph nodes.
What happens during growth spurts in relation to bones and muscles?
Bones grow faster than the attached muscle.
p.43
Motor Innervation of Lower Limb
What is the result of the push-off in the stance phase?
Plantarflexion by the forefoot.
p.29
venous Drainage of the lower limb
What are the deep veins of the lower limb associated with?
They accompany all major arteries and their branches.
p.22
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What does the subcutaneous tissue contain?
Fat, cutaneous nerves, superficial veins, lymphatic vessels, and lymph nodes.
p.41
Motor Innervation of Lower Limb
Why are the hip and knee joints stable in the stand-easy position?
Due to maximal contact of articular surfaces for weight transfer and taut supporting ligaments.
p.34
cutaneous innervation of lower limb
What is the significance of the axial line in dermatome maps?
It is the line of junction of dermatomes supplied from discontinuous spinal levels.
p.31
cutaneous innervation of lower limb
How is the dermatomal pattern of skin innervation affected during development?
It is distorted by limb lengthening and torsion.
What is a common initial symptom of a dislocated epiphysis of the femoral head?
Hip discomfort that may be referred to the knee.
What are common areas for avulsion fractures of the hip bone?
Anterior superior and inferior iliac spines, ischial tuberosities, and ischiopubic rami.
What is required to confirm a diagnosis of a dislocated epiphysis of the head of the femur?
Radiographic examination of the superior end of the femur.
What factors can influence the angle of inclination of the femur?
Age, sex, development of the femur, and pathological processes like rickets.
p.28
venous Drainage of the lower limb
What is the function of venous valves in the great saphenous vein?
To prevent reflux of blood and ensure unidirectional flow.
Why are tibial fractures in children more serious if they involve the epiphysial plates?
Because continued normal growth of the bone may be jeopardized.
p.36
venous Drainage of the lower limb
What happens to the valves in varicose veins?
They become incompetent due to dilation or rotation.
p.1
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What forms a prominence on the medial aspect of the foot?
The head of the 1st metatarsal.
What is the purpose of bone grafts?
To replace a destroyed segment of a major bone and avoid amputation.
p.40
cutaneous innervation of lower limb
Which nerves supply the plantar aspect of the foot?
Calcaneal branches of the tibial and sural nerves, and medial and lateral plantar nerves.
How are the thigh muscles separated?
Into three compartments: anterior, medial, and posterior.
What usually causes fractures of the greater trochanter and femoral shaft?
Direct trauma from falls or being hit.
p.43
Motor Innervation of Lower Limb
What increases lateral stability during relaxed standing?
The spread or splay of the feet.
p.37
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
Why is the great saphenous vein used for coronary arterial bypasses?
It is readily accessible and has a higher percentage of muscular and elastic fibers.
How does healing proceed after a fibular graft?
As if a fracture had occurred at each of its ends.
p.29
venous Drainage of the lower limb
What allows the saphenous veins to maintain uniform diameters despite receiving many tributaries?
Continuous shunting of blood from superficial veins to deep veins via perforating veins.
p.29
venous Drainage of the lower limb
What is the function of perforating veins?
They allow blood to flow only from superficial veins to deep veins and prevent backflow.
What can predispose a patient to nonunion of tibial bone fragments?
Fracture through the nutrient canal damaging the nutrient artery.
What are fibular fractures often associated with?
Fracture–dislocations of the ankle joint and tibial fractures.
What three primary bones form the hip bone?
Ilium, ischium, and pubis.
What type of fractures may occur during sports involving sudden acceleration or deceleration?
Avulsion fractures of the hip bone.
What type of fractures are common in people who take long hikes without conditioning?
Transverse march (stress) fractures of the inferior third of the tibia.
p.40
Lymphatic Drainage of the lower limb
What lymphatics follow the superficial veins in the lower limb?
Lymphatics that follow the saphenous veins to the superficial inguinal nodes.
Why is the proximal tibia preferred for IO infusion?
Due to the thinness of the skin and the existence of landmarks for correct insertion.
What are other sites for IO infusion?
Distal femur, tibia, fibula, proximal humerus, and manubrium.
p.25
deep fascia of the leg
What separates the superficial and deep plantarflexor muscles in the posterior compartment?
The transverse intermuscular septum.
What type of fractures may result from prolonged walking?
Fatigue fractures of the metatarsals.
What type of trauma usually causes proximal femur fractures?
Indirect trauma, such as stumbling or stepping down hard.
p.43
Motor Innervation of Lower Limb
What provides passive support in the relaxed standing position?
The ligaments of the hip and knee being tightly stretched.
What contributes to the instability of proximal femur fractures?
The angle of inclination and muscle spasm, which can cause limb shortening.
What condition may develop due to muscular inactivity during long flights?
Deep vein thrombosis (DVT) with thrombophlebitis.
What is the function of the deep fascia of the lower limb?
It limits outward expansion of contracting muscles, making muscular contraction more efficient in compressing veins to push blood toward the heart.
p.21
clinical box of the bone of lower limb
How do the bones of the foot assist in walking and running?
They transfer weight from the heel to the forefoot as required.
What is a potential outcome of a spiral fracture of the femoral shaft?
Foreshortening as the fragments override.
p.24
deep fascia of the leg
What does the deep fascia of the leg attach to?
The anterior and medial borders of the tibia, continuous with its periosteum.
p.29
venous Drainage of the lower limb
How do muscular contractions affect venous blood flow?
They compress perforating veins, propelling blood toward the heart against gravity.
p.36
venous Drainage of the lower limb
What is a common condition associated with the great saphenous vein?
Thrombophlebitis, leading to varicose veins.
p.21
clinical box of the bone of lower limb
What adaptations does the femur have for bipedal locomotion?
It has a bend (angle of inclination) and has twisted (medial rotation and torsion).
p.40
cutaneous innervation of lower limb
Which nerves primarily supply the thigh?
Lateral and posterior cutaneous nerves of the thigh and anterior cutaneous branches of the femoral nerve.
p.28
venous Drainage of the lower limb
What is the role of the musculovenous pump?
To help return blood to the heart against gravity.
p.43
Motor Innervation of Lower Limb
What adjustments are necessary to maintain the relaxed standing position?
Only minor postural adjustments by the extensors of the back and plantarflexors of the ankle.
What reinforces the fascia lata laterally?
Longitudinal fibers of the iliotibial tract, and the common aponeurotic tendon of the gluteus maximus and tensor fasciae latae.
p.21
clinical box of the bone of lower limb
What is the relationship between the tibia and fibula?
The tibia bears weight, while the fibula provides additional surface area for muscle attachment.
p.36
venous Drainage of the lower limb
What is a significant cause of thrombus formation?
Venous stasis (stagnation).
p.28
venous Drainage of the lower limb
What anatomical feature helps reduce back pressure in the great saphenous vein?
The valvular mechanism that breaks the column of blood into shorter segments.
What are free vascularized fibulas used for?
To restore skeletal integrity in congenital defects or after trauma.
p.39
cutaneous innervation of lower limb
How should peripheral nerve distribution be interpreted?
As anatomically different from dermatome distribution of spinal cord segments.
p.30
Lymphatic Drainage of the lower limb
Where do lymphatic vessels accompanying the great saphenous vein end?
In the vertical group of superficial inguinal lymph nodes.
p.37
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What happens to the great saphenous vein during a bypass procedure?
It is inverted to prevent valves from obstructing blood flow.
p.29
venous Drainage of the lower limb
Where does the small saphenous vein empty?
Into the popliteal vein in the popliteal fossa.
p.37
clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What is a saphenous cutdown?
A procedure to locate the great saphenous vein for cannula insertion.
Where does the iliotibial tract extend from and to?
From the iliac tubercle to the anterolateral tubercle of the tibia (Gerdy tubercle).
At what age does the tibial tuberosity usually form?
Approximately 10 years of age.
What is the os trigonum?
An accessory ossicle that may form when the secondary ossification center of the talus fails to unite with its body.
What is the primary cause of most lower limb injuries?
Acute trauma during contact sports and overuse during endurance sports.
p.40
Motor Innervation of Lower Limb
What is required for a person standing at ease?
Minimum muscular activity to prevent falling.
What is the function of the lateral intermuscular septum?
It offers an internervous plane for surgeons needing wide exposure of the femur.
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clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
What process transforms cartilaginous models of bones into bone?
Endochondral ossification.
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Motor Innervation of Lower Limb
How is lateral sway countered?
By the hip abductors acting through the iliotibial tract.
What complications can arise from fractures of the inferior or distal femur?
Separation of the condyles and hemorrhage from the popliteal artery.
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venous Drainage of the lower limb
What is the effect of removing the great saphenous vein on lower limb circulation?
It rarely produces significant problems if deep veins are intact.
Why is the junction of the middle and inferior thirds of the tibial shaft prone to fractures?
It has the poorest blood supply.
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clinical box of FASCIA, VEINS, LYMPHATICS, AND CUTANEOUS NERVES OF LOWER LIMB
How can the great saphenous vein be located in patients with collapsed veins?
By making a skin incision anterior to the medial malleolus.
Why are adolescents more vulnerable to lower limb injuries?
Due to the demands of sports on their maturing musculoskeletal systems.
During which activities are fractures of the greater trochanter and femoral shaft most common?
Motor vehicle accidents and sports like skiing and climbing.
What is the saphenous opening?
A gap in the fascia lata inferior to the medial part of the inguinal ligament.
Where does the fascia lata attach superiorly?
To the inguinal ligament, pubic arch, body of pubis, and pubic tubercle anteriorly.
What may result from the combined stress on the epiphysial plates during physical activity?
Irritation and injury of the plates.
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venous Drainage of the lower limb
What types of veins are present in the lower limb?
Superficial and deep veins.
Why do remaining parts of the fibula usually not regenerate after a segment is removed?
Because the periosteum and nutrient artery are generally removed with the bone.
What does the subcutaneous tissue in the lower limb do?
Insulates, stores fat, and provides passage for cutaneous nerves and superficial vessels.
What is the function of the deep fascia of the thigh and leg?
Limits outward bulging of muscles and facilitates venous return in deep veins.
What do modifications of the deep fascia include?
Openings for neurovascular structures and thickenings that retain tendons close to joints (retinacula).
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Motor Innervation of Lower Limb
How are lower limb muscle actions typically described?
As if the muscle were acting in isolation.
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venous Drainage of the lower limb
Where does the small saphenous vein arise?
On the lateral side of the foot from the union of the dorsal vein of the little toe and the dorsal venous arch.
What is the cribriform fascia?
A localized membranous layer of subcutaneous tissue that spreads over the saphenous opening.
What attaches to the fascia lata approximately a finger’s breadth inferior to the inguinal ligament?
The membranous layer of subcutaneous tissue (Scarpa fascia) of the inferior abdominal wall.
What does the fascia lata attach to inferiorly?
The deep fascia of the leg inferior to the knee.
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venous Drainage of the lower limb
What is the structure of accompanying veins in the limbs?
They usually occur as paired, frequently interconnecting veins that flank the artery.
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deep fascia of the leg
What are the extensor retinacula?
Thickened bands of deep fascia both superior and anterior to the ankle joint.
