LOWER EXTREMITY
Francis Neuffer, MD
USC SOM
Gross Anatomy / Radiology
OUTLINE
Hip
Knee
Ankle
Foot
Trauma
Degeneration
Vascular Injury
Sports Injury
FEMORAL HEAD
ACETABULUM
FEMORAL NECK
AP HIP
GREATER
TROCHANTER
FOVEA CAPITIS
LESSER
TROCHANTER
CORTICAL BONE
MEDULLARY BONE
RT. HIP
Pediatric
Adult
CORONAL MRI
RT. HIP
INTERTROCHANTERIC
FRACTURE
BONE DENSITY MEASUREMENT
NUCLEAR MEDICINE
POST OPERATIVE REPAIR
ACETABULAR
FRACTURE
Dashboard fracture
CT SCAN OF THE
PELVIS SHOWS
FRACTURE
AVASCULAR NECROSIS
FRACTURED LT. FEMUR
AP
LAT
DESCRIBE
THE
FRACTURE
AP
 BONE AND WHICH PART
 FRACTURE ORIENTATION AND PARTS
 DISPLACEMENT AND ANGULATION
 JOINT / SOFT TISSUE INVOLVEMENT
LAT
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.
DISTAL FEMUR
Lateral epicondyle
Lateral tibial
condyle
Head of fibula
KNEE
Medial epicondyle
Intercondylar
eminence
Medial tibial
condyle
Tibial tuberosity
KNEE
AP
LATERAL
Tendon Rupture
Which One?
MRI RIGHT KNEE
anterior
Scan level
MEDIAL
MEDIAL MENISCI
PCL
LATERAL MENISCI
ACL
PATELLA TENDON
LATERAL
SAGITAL MR KNEE
(MID JOINT)
QUADRICEPS TENDON
POSTERIOR CRUCIATE
LIGAMENT
PATELLA
PATELLAR
TENDON
ANTERIOR CRUCIATE
LIGAMENT
Scan level
PATELLA FRACTURE
NORMAL
NORMAL
QUADRACEPS
TENDON
INJURY
PATELLA
TENDON
INJURY
PATELLA TENDON RUPTURE
ANTERIOR CRUCIATE
LIGAMENT INJURY
Normal
POST OPERATIVE
LIGAMENT REPAIR
Stabilization of ligament
by surgical graft and screws
POSTERIOR CRUCIATE
LIGAMENT INJURY
Normal
MENISCUS
NORMAL
TORN
WHAT IS MY AGE?
POST OP
KNEE
REPLACEMENT
Degenerative
arthritis
POST-OP
LOWER LEG
TIBIAL
TUBEROSITY
HEAD OF
FIBULA
FIBULA
TIBIA
FIBULA
LATERAL
MALLEOLUS
MEDIAL
MALLEOLUS
AP
LATERAL
Tibial fracture shows spiral orientation
AP ANKLE
Fibular
shaft
Tibial
shaft
Medial malleolus
of the tibia
Lateral malleolus
of the fibula
Talus
LATERAL ANKLE
fibula
talus
calcaneus
cuboid
FRACTURES THROUGH THE
MEDIAL AND LATERAL
MALLEOLI.
THIS CT SCAN SHOWS FRACTURES
THROUGH THE MEDIAL AND LATERAL
MALEOLI.
SALTER INJURY TO GROWTH PLATE
AP FOOT
DIP
PIP
DISTAL PHALANX
MIDDLE PHALANX
MTP
PROXIMAL PHALANX
METATARSALS
V
IV III
II
I
SESAMOID
BONES
CUNIFORMS
3RD
2ND
1ST
SCAPHOID
CUBOID
TALUS
TARSALS
CALCANEUS
LATERAL FOOT
(NAVICULAR)
(3) CUNEIFORMS
TALUS
PHALANGES
SUSTENTACULUM
TALI
CUBOID
SESAMOID
BONE
CALCANEAL
TUBEROSITY
CALCANEAL
FRACTURE
PATIENT FELL OFF OF A LADDER
DIABETIC
OSTEOMYLITIS
Note air in soft tissues on right due to
bacterial growth.
BONE SCAN
OSTEOMYELITIS
Increased activity on bone scan supports
osteomylitis in metatarsal
GOUT
Urate crystal
deposits cause
inflammation
and erosion.
VASCULAR STRUCTURES
AP PELVIC ARTERIOGRAM
1
6
2
1.
ABDOMINAL
AORTA
2.
COMMON ILLIAC
ARTERY
3.
INTERNAL ILLIAC
ARTERY
4.
EXTERNAL ILLIAC
ARTERY
5.
COMMON
FEMORAL ARTERY
6.
LUMBAR ARTERY
3
4
5
CONVENTIONAL ANGIOGRAM
1= Common femoral artery
2= Superficial femoral artery
3= Profunda femoral artery (Deep artery of the
thigh)
4= Lateral femoral circumflex artery
1
4
3
2
CALCIFICATION outlines superficial
femoral artery.
ARTERIAL
CALCIFICATION
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
LOWER EXTREMITY ARTERIOGRAM
POPLITEAL ARTERY
4
Subtraction image
LOWER EXTREMITY ARTERIOGRAM
4.
5.
6.
7.
4
5
6
7
POPLITEAL ARTERY
ANTERIOR TIBIAL ARTERY
POSTERIOR TIBIAL ARTERY
FIBULAR ARTERY
SUPERFICIAL FEMORAL ARTERY
ARTERIOGRAM
BALLOON ANGIOPLASTY
OF SFA
INFERIOR
VENA CAVAGRAM
LEFT LOWER LEG VENOGRAM
4
2
3
4
2
1
1.
POPLITEAL VEIN
2.
FEMORAL VEIN
3.
PROFUNDA FEMORAL
VEIN
4.
GREAT SAPHENOUS
VEIN
VENOGRAM
AP projection
Popliteal vein
Calf veins
CALF VEIN THROMBUS
PULMONARY
EMBOLUS
Summary
Hip
Knee
Ankle
Foot
Trauma
Degeneration
Vascular Injury
Sports Injury