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A 28 year old motocross driver was involved in an accident during an exhibition show where the anterior surface of his left thigh was impaled with a metal rod

Biology

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A 28 year old motocross driver was involved in an accident during an exhibition show where the anterior surface of his left thigh was impaled with a metal rod.  He was rushed to the nearest hospital for emergency care. On physical examination his lower extremity was shortened and externally rotated at the mid-thigh. Pulses over the popliteal and dorsalis pedis was weak and thready. Xray done showed a mid-shaft fracture of the femur with the proximal fragment noted to be flexed, abducted and externally rotated. 

 

a. What muscles comprise the quadriceps?   

The quadriceps femoris consists of the rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. The quadriceps inserts into the patella, and via ligamentum patellae or patellar ligament, and attached to tibial tuberosity. Together, they provide a powerful extensor of the knee joint. 

 

b. Which muscle of the quadriceps crosses both the hip and knee joint? Give its origin  

 

The rectus femoris muscle is the only muscle of the quadriceps femoris that crosses the hip joint. Its straight head originates from the anterior inferior iliac spine and its reflected head originates from ilium above the acetabulum. The rectus femoris flexes the hip in addition to extension of the knee. 

 

c. Name the structure contained inside the femoral sheath from lateral to medial.  

The femoral sheath is a downward protrusion of the fascial lining of the abdominal walls into the thigh.  The sheath surrounds the femoral vessels and lymphatics for about 1 in. (2.5cm) below the inguinal ligament. The femoral artery, as it enters the thigh beneath the inguinal ligament, occupies the lateral component of the sheath.  The femoral vein, as it leaves the thigh, lies medially to the artery and occupies the intermediate compartment. Lymph vessels occupy the most medial compartment as they leave the thigh. The small medial compartment for lymph vessels is called the femoral canal and contains fatty connective tissue, all the efferent lymph vessels from the deep inguinal nodes, and one of the deep inguinal lymph nodes. 

 

d. What is the innervation of the quadriceps?  

 

e. What are the branches of the femoral artery? 

 

f. What are the muscles responsible for the flexed, abducted and externally rotated position of the proximal fragment of the fracture?