1. Lower Limbs Lu Xiaoli Regional Anatomy & Operative Surgery
China Medical University

2. Gluteal
Thigh
Knee
Leg
Ankle
Foot

3. 32 Bones Hip Bone (1) Femur (1) Patella (1) Tibia (1) Fibula (1)
Tarsals (8)
Metatarsals (5)
Proximal Phalanges (5)
Intermediate Phalanges (5)
Distal Phalanges (4)

4. Hip

9. Femoral Bone

13. Patella

14. Tibia & Fibula

17. Proximal End of Left Tibia

24. Gluteal Region

25. Iliac Crest
Gluteal Crease
Gluteal Cleft

26. Hip Joint Superficial Layers Deep Layers Skin Superficial Fascia
Deep Fascia
Muscles
Suprapiriform & Infrapiriform Foramen
Lesser Sciatic Foramen
Hip Joint

27. Superficial Fascia the middle part is thinnest
Contains Superficial blood vessels, lymphatic vessels and cutaneous nerves

28. Bedsore (Decubitus Ulcer)
A pressure-induced ulceration of the skin occurring in persons confined to bed for long periods of time. Also called decubitus ulcer, pressure sore.
Bedsore (Decubitus Ulcer)

29. Arteries Superficial branches of 4th lumbar artery
Inferior gluteal artery
Lateral sacral artery
Superior gluteal artery

30. Cutaneous Nerves branches of the subcostal nerve (T12)
dorsal rami of lumbar nerves
dorsal rami of sacral nerves
inferior cluneal nerves
posterior femoral cutaneous nerve

31. Deep Fascia Attach to iliac crest superiorly Invest gluteus maximus
Attach to Sacral bone and coccyx medially
Continuous with fascia lata laterally

32. Muscles Superficial Gluteus Maximus Tensor Fasciae Latae
Glluteus Medius
Piriformis
Superior Gemellus
Obturator Internus
Inferior Gemellus
Quadratus Femoris
Middle
Deep
Gluteus Minimus
Obturator Externus

33. Gluteus Maxinus
Tensor Fasciae Latae

34. Glluteus Medius
Piriformis
Superior Gemellus
Obturator Internus
Inferior Gemellus
Quadratus Femoris

35. Gluteus Minimus
Obturator Externus

36. Suprapiriform Foramen
greater sciatic notch
Piriformis
Lateral to medial: Superior gluteal n.– a.– v.

37. Infrapiriform Foramen
Piriformis
Ischial spine & sacrospinous ligament
Lateral to medial: sciatic n.– posterior femoral cutaneous n. – inferior gluteal n. a. & v.– internal pudendal a. & v. – pudendal n.

38. Sciatic n.
Tibial n.
Common Fibular n.

39. 66.3%
27.3%
Tibial n.
Common Fibular n.
6.4%

41. Piriformis Syndrome
Pain radiates down the back of the leg

42. Iliac crest
Ischial tuberosity

43. Lesser Sciatic Foramen
Boundaries
front: tuberosity of ischium
above: spine of ischium & sacrospinous lig.
behind: sacrotuberous lig.
Contents
tendon of Obturator internus
internal pudendal a.
internal pudendal v.
pudendal n.

47. Hip Anterior Posterior
it does not reach down as far as the trochanteric crest.
Posterior

48. It is based on this capsular attachment that fractures of the neck of femur are classified as:
INTRACAPSULAR: within the capsular attachment.
EXTRACAPSULAR: outside the attachment of the capsule
Mixed

49. Intracapsular
Lig. of head of femur
Transverse acetabular lig.

50. Extracapsular (Anterior)
Iliofemoral lig.
Pubofemoral lig.

51. Extracapsular (posterior)
Ischiofemoral lig.
Zona orbicularis

52. Blood Supply Superior gluteal a. Inferior gluteal a.
Lateral circumflex femoral a.
Medial Circumflex femoral a.
Branches of Obturator a.
1st perforating branches of deep femoral a.
Femoral nutrient a.

53. Superior gluteal a.
Inferior gluteal a.
1st perforating branches of deep femoral a.

54. Superior retinacular a.
Anterior retinacular a.
Inferior retinacular a.
Medial Circumflex femoral a.
Lateral circumflex femoral a.

55. Branches of Obturator a.

56. Femoral nutrient a.

57. If the head of the femur is dislocated postero-medially, compression of which nerve is likely to result?
Femoral
Lumbosacral trunk
Obturator
Sciatic
Superior gluteal

58. What muscle passes through the lesser sciatic foramen?
Gluteus minimus
Obturator internus
Piriformis
Quadratus femoris
Superior gemellus

59. In order to avoid injury to the sciatic nerve, intramuscular injections should be given in which quadrant of the buttock?
upper medial
upper lateral
lower medial
lower lateral
middle

60. Of the branches of the internal iliac artery, the one exiting from the greater sciatic foramen superior to the piriformis muscle is the:
Iliolumbar artery
Internal pudendal artery
Lateral sacral artery
Superior gluteal artery

61. Thigh

62. Anterior compartment
Posterior compartment

64. Superficial iliac circumflex a.
Superficial epigastric a.
External pudendal a.
Superficial lateral femoral a.
Superficial medial femoral a.

65. Groin Flap

66. Great Saphenous V. 70 ～80 cm femoral v. fossa ovalis
medial side of thigh
medial condyles of tibia & femur
medial side of leg
medial malleolus
dorsal venous arch of foot

67. Tributaries Superficial iliac circumflex v. Superficial epigastric v.
External pudendal v.
Superficial lateral femoral v.
Superficial medial femoral v.
surgical ligation

68. in emergency, great saphenous vein may be opened surgically for intravenous drip for the patients suffering from insufficiency of body fluid.
great saphenous vein as venous graft can be used in the coronary bypass surgery for coronary heart disease.

69. one-way valves become weak & don't close properly

71. Superficial inguinal LN
Horizontal groups
Vertical groups

73. Fascia Lata Iliotibial tract Saphenous hiatus (fossa ovalis )
fascia cribrosa
Falciform margin

74. Lacuna musculorum & vasorum
between inguinal lig. and hip bone, and separated by iliopectineal arch
lateral: lacuna musculorum
medial: lacuna vasorum

75. Lacuna musculorum Boundaries: Contents: ant.：inguinal lig. post.：ilium
med.：iliopectineal arch
Contents:
iliopsoas
lat. femoral cutaneous n.
femoral n.

77. Lacuna vasorum Boundaries: Contents: ant.：inguinal lig.
post.：pectineal lig.
med.：lacunar lig.
lat.： iliopectineal arch
Contents:
femoral sheath
femoral a., v.
femoral canal
femoral br. of genitofemoral n.

80. Femoral sheath

81. Femoral canal 1-1.5 cm Boundaries:
Ant. : inguinal lig. superior corner of falciform margin and femoral septum
Post. : pectineal lig., pectineus
Lat. : fibrous septum of femoral v.

82. femoral ring ant. : inguinal lig. med. : lacunar lig.，
post. : pectineal lig.
lat. : fibrous septum of medial side of femoral v.

85. A 63-year-old female patient says that she has pain in her groin and upper thigh. Upon examination, you palpate a lump located below the inguinal ligament lateral to its attachment to the pubic tubercle. You suspect that this may be a hernia passing through the:
femoral canal
adductor hiatus
obturator canal
deep inguinal ring
superficial inguinal ring A

86. The femoral canal contains the:
Deep inguinal lymph node(s)
Femoral artery
Femoral nerve
Femoral vein
Ilioinguinal nerve A

87. The pulse of the femoral artery is best felt at which superficial reference point?
Anterior to the ankle joint
Femoral triangle
Mid-thigh
Popliteal fossa
Right lateral portion of the hypogastrium B

88. At which site could one expect to enter the femoral vein with a simple percutaneous (through the skin) introduction of an instrument?
Above the middle of the inguinal ligament
Lateral to the femoral arterial pulse
Lateral to the pubic tubercle
Medial to the femoral arterial pulse
Medial to the pubic tubercle D

89. A serious complication of fractures of the femoral neck is avascular necrosis of the femoral head. This usually results from rupture of which artery?
Acetabular branch of obturator
Deep circumflex iliac
Descending branch of lateral circumflex femoral
Medial circumflex femoral
Second perforating branch of lateral circumflex D

90. A ruptured aneurysm in the most proximal portion of the deep femoral artery would result in a hematoma located initially in the:
Adductor canal.
Femoral canal.
Femoral triangle.
Inguinal canal.
Popliteal fossa.

91. Childhood immunizations are sometimes given via intramuscular injections into the quadriceps muscles of the anterior thigh. At the mid-thigh level, a needle passing into the space deep to the sartorius muscle might pierce the femoral vessels as they lie in the:
Adductor canal
Adductor hiatus
Adductor triangle
Femoral canal
Femoral ring

92. Which of the following is NOT located within the adductor canal?
Saphenous nerve
Femoral artery
Nerve to vastus medialis
Femoral vein
Deep femoral artery

93. THANKS!