Lower limb Cases

Case 1 A 42-year-old diabetic woman complains of soreness of the left leg. She is moderately obese and has been recovering from surgical removal of her gallbladder (cholecystectomy) performed 2 weeks ago. On examination, she has obvious swelling in the left lower leg and some tenderness of the calf that increases when the calf is gently squeezed. There is no redness of the leg, and she is afebrile (without fever).

What is the most likely diagnosis? What structure is likely affected?

Most likely diagnosis: Deep venous thrombosis (DVT) Structure likely affected: Anterior and posterior tibial veins and fibular veins

Objectives 1 Be able to draw the arterial blood supply to the lower limb. 2. Be able to describe the deep and superficial venous drainage of the lower limb.

1 As an orthopedic surgeon is operating in the posterior compartment of the thigh, care is taken to preserve the arterial blood supply to the muscles in that region. These are branches of which of the following arteries? A. Deep femoral artery B. Femoral artery C. Superior gluteal artery D. Inferior gluteal artery E. Obturator artery

2 Which are the chief deep veins of the leg that are of concern for DVT? A. Small saphenous vein B. Great saphenous vein C. Deep femoral vein D. Anterior and posterior tibial veins E. Obturator vein

Case A 25-year-old woman is on her first ski trip to Colorado. She has advanced from the “bunny slopes” and, during the last run of the day, falls and twists her right leg. She cannot stand on her right leg due to pain and is brought down the hill in a snow mobile. On examination, the right knee is swollen and tender. With the patient sitting on the stretcher with her knee flexed, the lower leg seems to have several centimeters of excess anterior mobility.

What is the most likely diagnosis? What is the mechanism of the injury?

Most likely diagnosis: Anterior cruciate ligament (ACL) tear Mechanism of injury: Excessive rotational force strains or ruptures the ligament

1 which of the following ligaments prevented posterior displacement of the tibia on the femur? A. Oblique popliteal B. Anterior cruciate C. Posterior cruciate D. Lateral collateral E. Medial collateral