Blood supply to the femoral head and neck fractures.

In young, epiphysis end of head supplied by small branch of obturator artery. Upper part of neck of femur receives supply from medial circumflex artery. As long as epiphysal cartilage remains these do not form anastomosis. In adult, this cartilage disappears and anastomosis is established. Fracture of neck completely interferes with the blood supply. So the ischemic necrosis takes place in adults. Coxa Valga and Vara Increase in angle than 125 coxa valga. Happens in congenital dislocation of hip. Adduction limited. Decrease coxa vara. Happens in fractures of neck of femur. Abduction limited. Fractures of femur Two types. SUBCAPITAL and TRONCHANTERIC . Subcapital in elderly by minor trip or stumble. Common in women after menopause. Avascular necrosis. Strong muscles such as adductor mucles, hamstring muscles and RF pull distal fragment upward causing shortening of leg. GM, PI, OI, GE, QF rotate the leg laterally. Tronchanteric common in young and middle aged due to trauma. Extra capsular. Shortening and lateral rotation. FRACTURES OF SHAFT. Upper 1/3rd, flexed by iliopsoas, abducted by G.med and min. and laterally rotated by GM,PI,OI,DF,Gemilli. Middle 1/3rd distal fragment pulled by Quad fem. Resulting in shortnening. In distal 1/3rd same as middle 1/3rd to a greater degree but due to gastrosnemuis and interferes with poplieal artery in leg and foot. POLIOMYELITIS AFFECTS GLUTEUS MAXIMUS AND MEDIUS. Varicose vein One with the larger diameter. Common in superficial veins of LL. Causes: hereditary weakness of veins and incompetent valves, elevated intra abdominal pressure (due to multiple pregnancies, tumors), thrombophlebitis of deep veins which causes superficial to become main vein supply to LL. Great saphenous vein cutdown Usually performed at ankle. Disadvantage is phlebitis (inflammation of vein wall). This is rare at groin in femoral triangle. Lymphatics of lower limb. Superficial and deep ILN drain LL, skin and superficial fascia from anterior and posterior abdominal wall below the umbilicus, external genetalia and mucus membrane of anal canal. Large painful ILN can be due to pathogenic organism that entered from the surface of big toe. Quadriceps femoris as knee joint stabilizer Most imp extensor muscle for knee joint. In knee joint disease these mucles should be testes carefully of both legs. Reduction can be caused by muscles atrophy. VASTUS MEDIALIS IS THE FIRST IN ATROPHY IN KNEE JOINT DISEASE AND LAST TO RECOVER.

Rupture of rectus femoris Can rupture in sudden violent extension of knee joint. Muscle belly retracts proximally, leaving gap in anterior surface of thigh. Rupture of ligamentum patellae. When sudden flexing force is applied when QF are actively contracting. Femoral hernia More common in female than men due to wider pelvis. The hernial sac passes down the femoral canal, pushing the femoral septum before it. On escaping through lower end of femoral canal its it forms swelling on upper part of deep thigh to the deep fascia. The neck of the sac lies below and lateral to pubic tubercle with contrast to the inguinal hernia which lies above and medial to pubic tubercle. Ring is covered anteriorly-inguinal ligament, posterioly-superior ramus of pubis laterally-femoral vein and medially-laclunar ligament. Thats why it cant expand. If blood vessels comporessed on coughing or due to piece of bowel, ateries compress casing strangulated hernia. However there can be other reasons than femoral hernia of the swelling .these are: inguinal canal hernia, enlargement of superical lymph node due to lymphdentitis(a small unnoticed abrasion maybe present. MUCOUS MEMBRANE OF LOWER ANAL CANAL CAN BE AFFECTED IT MAY HAVE UNDISCOVERED CARCINOMA), great saphenous vein dilation, saphenous varix, varicose vein elsewhere in body help in diagnosis, swelling of fem artery fluctuates with pulse rate, psoas sheath infection in tuberclosrisis, swelling above n below inguinal lig help in making diagnosis obvious.