Clinical Anatomy,Pathology of Bones of The Thigh and Leg
Fracture of the femoral head is a rare injury caused by posterior hip dislocation in advanced age (osteoporosis) and requires hip replacement. It presents as a shortened lower limb with medial rotation.
Fracture of the neck of the femur results in ischemic necrosis of the neck and head because of an interruption of blood supply from the root of the femoral neck to the femoral head by the medial femoral circumfl ex artery, except for its small proximal part. It causes a pull of the distal fragment upward by the quadriceps femoris, adductors, and hamstring muscles so that the affected lower limb is shortened with lateral rotation.
Pertrochanteric fracture is a femoral fracture through the trochanters and is a form of the extracapsular hip fracture. The pull of the quadriceps femoris, adductors, and hamstring muscles may produce shortening and lateral rotation of the leg. It is common in elderly women because of an increased incidence of osteoporosis. In fracture of the middle third of the femoral shaft, the proximal fragment is pulled by the quadriceps and the hamstrings, resulting in shortening, and the distal fragment is rotated backward by the two heads of the gastrocnemius.
A dislocated knee or fractured distal femur may injure the popliteal artery because of its deep position adjacent to the femur and the knee joint capsule.
Transverse patellar fracture results from a blow to the knee or from sudden contraction of the quadriceps muscle. The proximal fragment of the patella is pulled superiorly with the quadriceps tendon, and the distal fragment remains with the patellar ligament.
Bumper fracture is a fracture of the lateral tibial condyle that is caused by an automobile bumper, and it is usually associated with a common peroneal nerve injury.
Pott’s fracture (Dupuytren’s fracture) is a fracture of the lower end of the fi bula, often accompanied by fracture of the medial malleolus or rupture of the deltoid ligament. It is caused by forced eversion of the foot.
Pillion fracture is a T-shaped fracture of the distal femur with displacement of the condyles. It may be caused by a blow to the fl exed knee of a person riding pillion on a motorcycle.
Fracture of the fibular neck may cause an injury to the common peroneal nerve, which winds laterally around the neck of the fi bula. This injury results in paralysis of all muscles in the anterior and lateral compartments of the leg (dorsifl exors and evertors of the foot), causing foot drop.