The anatomy of fractures of the calcaneus

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The anatomy of fractures of the calcaneus

• The calcaneus has three articular facets
• The calcaneus articulates with the talus and
  cuboid
• An intra-articular fracture disrupts the
  relationship of the sub-talar facets
• The sustentaculum tali is a lateral projection of
  the calcaneum

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The anatomy of the femoral artery

• Is the continuation of the external iliac artery
  at the inguinal ligament
• Leaves the thigh through the adductor hiatus to
  become the popliteal artery
• The profunda femoris artery is its only branch
• Lies lateral to the femoral nerve in the femoral
  triangle

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The anatomy of the femoral nerve

• Is a branch of the lumbar plexus derived from the
  anterior divisions of L2,3 4
• Is a predominantly cutaneous nerve and the
  quadriceps is the only muscle supplied
• Divides into anterior and posterior divisions in
  the thigh
• The saphenous nerve is the major cutaneous branch

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Anterior Division

• Intermediate and medial cutaneous nerves of thigh
• Nerves to Pectineus and Sartorius

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Posterior Division

• Motor to quadriceps
• Articular branches to knee joint
• Saphenous nerve

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The following are features of an injury to the
sciatic nerve

• Foot drop
• Weakness of quadriceps and loss of knee jerk
• Loss of sensation on the dorsum of the first web
• Loss of sensation on the medial side of the leg

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Sciatic nerve

• Articular branches to hip, motor to biceps,
  semitendinosus, semimembranosus and adductor
  magnus
• Tibial and Common Peroneal nerves

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Tibial nerve

• Gastrocnemius, soleus, popliteus, plantaris
• Tib post., FHL. FDL
• Sural nerve (lateral foot)
• Medial and lateral plantar nerves

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Common peroneal nerve

• Lateral sural cutaenous nerve
• Superficial and deep branches
• Superficial to lateral/peroneal compartment
• Deep branch to anterior compartment medial
  terminal branch supplies dorsal first web

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The compartments of the lower leg

• There are 4 compartments anterior, lateral,
  deep and superficial posterior.
• The posterior tibial nerve is in the lateral
  compartment and supplies sensation to the sole of
  the foot
• The deep peroneal nerve is in the anterior
  compartment and supplies sensation in the dorsal
  first web
• The posterior tibial nerve is in the deep
  posterior compartment

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The lateral ligament of the ankle

• The lateral ligament has three bands
• The anterior talofibular band runs from the
  lateral malleolus to the anterolateral talus
• The strongest portion of the ligament is the
  posterior talofibular band
• The middle band inserts into the tubercle of the
  talus

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The blood supply of the femoral head and neck

• Is dependant on direct branches of the gluteal
  arteries
• May be maintained by the artery of ligamentum
  teres
• The head is dependent on retinacular and
  intra-osseous vessels
• In adults there is significant anastomosis of
  epiphyseal and metaphyseal vessels

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The tibial (medial) collateral ligament of the
knee

• Can be divided into deep and superficial portions
• Has no attachment to the medial meniscus
• The superficial portion attaches to the tibia
  immediately below the joint line
• The deep portion blends with the capsule and the
  posterior oblique ligament posteriorly

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The anterior cruciate ligament

• Lies within the synovium
• It runs posteriorly, superiorly and laterally
• It has a good supply from a direct branch of the
  popliteal artey
• Is a restraint to anterior tibial translation and
  guides the screw home mechanism of the knee

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The menisci

• The menisci cover less than half of the
  corresponding articular surface of the tibia
• The lateral meniscus is a more open C shape and
  is attached to the lateral (fibular) collateral
  ligament.
• Are well vascularised
• The anterior horn of the medial meniscus is wider
  than the posterior

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The anatomy of the talus

• The blood supply to the talus enters
  predominantly through the body leaving the head
  vulnerable to avascular necrosis
• The neck of the talus forms the roof of the sinus
  tarsi
• The majority of the surface of the talus is
  covered by articular cartilage
• The main blood supply to the talus is from a
  branch of the anterior tibial artery

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