Thigh Anatomy

Front 1

What is the average neck shaft angle of the femur?
What is the average femoral anteversion?
What type of bowing does the femur have?
Which femoral condyle is larger?

Back 1

Avg. Neck Shaft Angle: 127 degrees
Avg. Anteversion: 14 degrees (range 1-40 degrees)
Femur has an anterior bow
The medial condyle is larger

Front 2

What are the 2 important centers for ossification of the femur? When do these ossify and fuse?

Back 2

The head and distal femur

Head & trochanters: Ossify at 11 months, fuse at 18 years

Distal Femur: Present at birth, fuse at 19 years

Front 3

Through what growth zone does SCFE occur?

Back 3

Slipped capital femoral epiphysis occurs through the femoral head physis (zone of hypertrophy)

Front 4

What is the origin, insertion, and innervation for the following muscle?
Vastus lateralis

Back 4

Origin: Iliotibial line/greater trochanter/lateral linea aspera
Insertion: Lateral patella
Action: Extends knee
Innervation: Femoral

Front 5

What is the origin, insertion, and innervation for the following muscle?
Vasus medialis

Back 5

Origin: Iliotibial line/medial linea aspera/supracondylar line
Insertion: Medial patella
Action: Extends knee
Innervation: Femoral

Front 6

What is the origin, insertion, and innervation for the following muscle?
Vastus intermedius

Back 6

Origin: Proximal anterior femoral shaft
Insertion: Patella
Action: Extends the knee
Innervation: Femoral

Front 7

What is the origin, insertion, and innervation for the following muscle?
Biceps femoris (long head)

Back 7

Origin: Medial ischial tuberosity
Insertion: Fibular head/lateral tibial condyle
Innervation: Tibial

Front 8

What is the origin, insertion, and innervation for the following muscle?
Biceps femoris (short head)

Back 8

Origin: Lateral linea aspera/lateral intermuscular septum/lateral supracondylar ridge
Insertion: Fibular head, Lateral tibial condyle
Innervation: Peroneal

Front 9

What is the origin, insertion, and innervation for the following muscle?
Semitendinosus

Back 9

Origin: Distal medial ischial tuberosity
Insertion: Anterior tibial crest (pes anserinus)
Action: Extends thigh, flexes knee, rotates tibia medially (especilly w/ flexed knee)
Innervation: Tibial

Front 10

What is the origin, insertion, and innervation for the following muscle?
Semimembranosus

Back 10

Origin: Proximal lateral ischial tuberosity
Insertions: Posterior surface of the medial tibial condyle (?oblique popliteal ligament)
Posterior capsule
Posterior/medial tibia
Popliteus
Medial meniscus

Innervation: Tibial

Front 11

Back 11

p

Front 12

Back 12

m

Front 13

Back 13

D

Front 14

In most people, what is the relationship of the sciatic nerve to the piriformis and other short external rotators?

Back 14

Emerges from its foramen anterior to the piriformis and posterior to the other short external rotators

Front 15

What is the path of the sciatic nerve through the leg? What muscles does it run between?

Back 15

Descends below the gluteus maximus and proceeds posteriorly to the adductor magnus and between the long head of the biceps femoris and semimembranosus. Before it emerges from the popliteal fossa, it divides into the common peroneal nerve and the tibial nerve

Front 16

How many muscles does the peroneal nerve innervate in the thigh?

Back 16

The peroneal division has one innervation in the thigh: the short head of the biceps femoris

Front 17

What muscle does the common peroneal nerve run under in the thigh?

Back 17

The biceps femoris

Front 18

The tibial nerve emerges into the popliteal fossa laterally, proceeds posteriorly to the vessel, and then descends under what muscle?

Back 18

Between the heads of the gastrocnemius.

Front 19

What is the largest branch of the femoral nerve?

Back 19

The saphenous nerve

Front 20

What area does the infrapatellar branch of the saphenous nerve supply?

Back 20

The infrapatellar branch of the saphenous nerve supplies the skin of the medial side of the front of the knee and patellar ligament and can be damaged during total knee replacement surgery

Front 21

What spinal levels correspond to the femoral nerve?

Back 21

L2-L4

Front 22

What nerve allows hip pathology to refer pain to the knee?

Back 22

The anterior branch of the obturator nerve can provide sensation to the medial side of the knee and can be a source of referred pain from hip pathology

Front 23

What radiographic landmark is the location of where the aorta branches into the common iliac arteries?

Back 23

Anterior to the L4 vertebral body

Front 24

Name the branches to the lower extremity from the aorta including the important branches from the internal and external iliacs

Back 24

Aorta --> Common Iliacs --> Internal & External Iliacs

Internal lliac -->
Obturator artery
Superior gluteal artery
Inferior gluteal artery
Internal pudendal (reenters through lesser sciat)

External Iliac becomes the femoral artery after passing under the inguinal ligament.
Femoral artery --> deep and superficial femoral aa.
Deep --> medial and lateral femoral circumflex aa.

Front 25

Obturator artery and vein can be jeopardized by what most commonly?

Back 25

Anteroinferior screws and acetabular retractors

Front 26

What is the corona mortis? Why is it important?

Back 26

It is an anastomotic connection between the inferior epigastric branch of the external iliac vessels and the obturator vessels in the obturator canal.

It can lead to life-threatening bleeding if injured

Front 27

In an adult, what is the major blood supply to the femoral head and where is it found anatomically?

Back 27

The medial femoral circumflex artery. It is found anterior to the quadratus femoris

Front 28

After giving off the deep femoral artery, how does the SFA travel distally? What branch does it give off above the medial femoral condyle? Where does it go from there?

Back 28

It descends under the cover of the sartorius and proceeds between the adductor group and the vastus medialis into the adductor canal.

Above the medial femoral condyle it gives off the descending geniculate branch then passes through a defect in the adductor magnus (adductor hiatus) into the popliteal fossa becoming the popliteal artery

Front 29

Which is more superficial in the adductor hiatus, the popliteal artery or vein?

Back 29

Vein

Front 30

A branch of what artery supplies the ligamentum teres acetabular artery which is an important source of blood to the femoral head from birth to the age of 4?

Back 30

The posterior branch of the obturator artery

Front 31

What approach to the thigh is used for ORIF of intertroch and femoral neck fractures and can be extended for access to shaft and supracondylar fractures?
What is the interval?
Describe the dissection

Back 31

Lateral approach
There is no interval.

Split the fascia lata in line with the femoral shaft.
□ If necessary, include part of the tensor fasciae latae.
□ Then bluntly dissect the vastus lateralis in line with its fibers, or dissect the fibers of the intermuscular septum.
□ Identify and cauterize the various perforators from the profunda femoris

Front 32

What is the interval for the posterolateral approach to the thigh?
Describe the dissection.

Back 32

Between the vastus lateralis (femoral nerve) and hamstrings (sciatic nerve)

Dissection: Incise the fascia under the iliotibial band and retract the vastus superiorly. Continue anteriorly to the lateral intermuscular septum with blunt dissection until the periosteum over the linea aspera is reached

Front 33

What is the interval for the anteromedial approach to the distal femur?
Describe the dissection

Back 33

Interval: between the rectus femoris and vastus medialis (femoral nerve) and extending to a point medial to the patella

Dissection:
□ Retract the rectus laterally.
□ Explore the interval to reveal the vastus intermedius.
□ It may be necessary to open the knee joint.
□ If so, incise the medial patellar retinaculum and split a portion of the quadriceps tendon just lateral to the medial border.
□ After identifying the vastus intermedius, split it along its fibers to expose the femur.

Front 34

What vessels and nerves are at risk in the anteromedial approach to the distal femur?

Back 34

□ The medial superior geniculate artery and the infrapatellar branch of the saphenous nerve can be injured because both cross the site of exposure.
□ In addition, an adequate cuff of tissue must be left for a strong patellar retinacular repair; otherwise, there is a risk of lateral subluxation of the patella.