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LOWER EXTREMITY

LOWER EXTREMITY. Francis Neuffer, MD USC SOM Gross Anatomy / Radiology. OUTLINE. Hip Trauma Knee Degeneration Ankle Vascular Injury Foot Sports Injury. FEMORAL HEAD. ACETABULUM. FEMORAL NECK. AP HIP . GREATER TROCHANTER. FOVEA CAPITIS. LESSER TROCHANTER.

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LOWER EXTREMITY

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

  2. OUTLINE Hip Trauma Knee Degeneration Ankle Vascular Injury Foot Sports Injury

  3. FEMORAL HEAD ACETABULUM FEMORAL NECK AP HIP GREATER TROCHANTER FOVEA CAPITIS LESSER TROCHANTER CORTICAL BONE MEDULLARY BONE

  4. RT. HIP Pediatric Adult

  5. CORONAL MRI RT. HIP

  6. INTERTROCHANTERIC FRACTURE

  7. BONE DENSITY MEASUREMENT NUCLEAR MEDICINE

  8. POST OPERATIVE REPAIR

  9. ACETABULAR FRACTURE Dashboard fracture CT SCAN OF THE PELVIS SHOWS FRACTURE

  10. AVASCULAR NECROSIS Bone scan X-ray MRI

  11. FRACTURED LT. FEMUR LAT AP

  12. DESCRIBE THE FRACTURE AP • BONE AND WHICH PART • FRACTURE ORIENTATION AND PARTS • DISPLACEMENT AND ANGULATION • JOINT / SOFT TISSUE INVOLVEMENT LAT

  13. 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.

  14. DISTAL FEMUR KNEE Medial epicondyle Lateral epicondyle Lateral tibial condyle Intercondylar eminence Medial tibial condyle Head of fibula Tibial tuberosity

  15. KNEE LATERAL AP

  16. Tendon Rupture Which One?

  17. MRI RIGHT KNEE coronal section anterior Scan level

  18. MEDIAL - Sagittal sections MEDIAL MENISCI PCL LATERAL MENISCI ACL PATELLA TENDON LATERAL

  19. SAGITAL MR KNEE (MID JOINT) QUADRICEPS TENDON POSTERIOR CRUCIATE LIGAMENT Scan level PATELLA ANTERIOR CRUCIATE LIGAMENT PATELLAR TENDON

  20. PATELLA FRACTURE NORMAL

  21. NORMAL QUADRACEPS TENDON INJURY PATELLA TENDON INJURY

  22. PATELLA TENDON RUPTURE

  23. ANTERIOR CRUCIATE LIGAMENT INJURY Normal

  24. POST OPERATIVE LIGAMENT REPAIR Stabilization of ligament by surgical graft and screws

  25. POSTERIOR CRUCIATE LIGAMENT INJURY Normal

  26. MENISCUS NORMAL TORN

  27. WHAT IS MY AGE?

  28. POST OP KNEE REPLACEMENT Degenerative arthritis POST-OP

  29. LOWER LEG TIBIAL TUBEROSITY HEAD OF FIBULA FIBULA TIBIA FIBULA LATERAL MALLEOLUS MEDIAL MALLEOLUS AP LATERAL

  30. Tibial fracture shows spiral orientation

  31. AP ANKLE Tibial shaft Fibular shaft Medial malleolus of the tibia Lateral malleolus of the fibula Talus

  32. LATERAL ANKLE tibia fibula talus navicular cuboid calcaneus

  33. FRACTURES THROUGH THE MEDIAL AND LATERAL MALLEOLI.

  34. THIS CT SCAN SHOWS FRACTURES THROUGH THE MEDIAL AND LATERAL MALEOLI.

  35. SALTER INJURY TO GROWTH PLATE

  36. AP FOOT DIP PIP DISTAL PHALANX MIDDLE PHALANX PROXIMAL PHALANX PHALANGES MTP CUNIFORMS METATARSALS SESAMOID BONES 3RD 2ND 1ST IV III II I V SCAPHOID CUBOID TALUS TARSALS CALCANEUS

  37. LATERAL FOOT (NAVICULAR) (3) CUNEIFORMS TALUS METATARSALS PHALANGES SUSTENTACULUM TALI CALCANEUS CUBOID SESAMOID BONE CALCANEAL TUBEROSITY

  38. CALCANEAL FRACTURE PATIENT FELL OFF OF A LADDER

  39. DIABETIC OSTEOMYLITIS Note air in soft tissues on right due to bacterial growth.

  40. BONE SCAN OSTEOMYELITIS Increased activity on bone scan supports osteomylitis in metatarsal

  41. GOUT Urate crystal deposits cause inflammation and erosion.

  42. VASCULAR STRUCTURES

  43. AP PELVIC ARTERIOGRAM 1 6 • ABDOMINAL AORTA • COMMON ILLIAC ARTERY • INTERNAL ILLIAC ARTERY • EXTERNAL ILLIAC ARTERY • COMMON FEMORAL ARTERY • LUMBAR ARTERY 2 3 4 5

  44. 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. 1 4 3 2

  45. ARTERIAL CALCIFICATION

  46. LOWER EXTREMITY ARTERIOGRAM 1 2 1 2 3 3 • COMMON FEMORAL ARTERY • PROFUNDA FEMORIS ARTERY (Deep artery of the thigh) • SUPERFICIAL FEMORAL ARTERY

  47. LOWER EXTREMITY ARTERIOGRAM POPLITEAL ARTERY 4 Subtraction image

  48. LOWER EXTREMITY ARTERIOGRAM • 4. POPLITEAL ARTERY • ANTERIOR TIBIAL ARTERY • POSTERIOR TIBIAL ARTERY • 7. FIBULAR ARTERY 4 5 6 7

  49. SUPERFICIAL FEMORAL ARTERY ARTERIOGRAM

  50. BALLOON ANGIOPLASTY OF SFA

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