Q: Why is there foot drop after Fractured neck fibula?

FOOT DROP-
Paralysis of the muscles of the anterior compartment of the leg results in loss of the power of
dorsiflexion of the foot. As a result, the foot is plantar flexed. The condition is called foot drop.
COURSE OF COMMON PERONEAL NERVE-
At the upper end of Popliteal Fossa, the Sciatic Nerve divides into the common peroneal branch
and the tibial nerve.
The common peroneal nerve follows the edge of Biceps femoris and then winds around the neck
of the fibula to further divide into the Superficial and Deep Branches.
The deep branch supplies the dorsiflexors of the leg i.e.
• Tibialis Longus
• Extensor Digitorum Longus
• Extensor Digitorum Brevis (in the foot)
• Extensor Hallucis Longus
The Superficial Branch supplies the Peroneus Longus and Brevis. These are responsible for
eversion of foot.
In a fractured neck of fibula, the common peroneal nerve gets damaged. So,
There is unopposed flexion due to paralysis of dorsiflexor muscles.
The paralysis of PL and PB leads to unopposed inversion of foot.
This results in “foot drop”

Q. Peroneus Longus has effect on Both longitudinal and Transverse arch of foot.
Peroneus longus is a muscle that is bipinnate at the upper end and unipennate at the lower end. It
originates at the upper 2/3 of the fibula and inserts at 2 places:
1) Medial side of cuneiform bone by passing under the cuboid bone
2) Inferolateral side of the 1st metatarsal
Transverse Arch:
As the tendon of the peroneus longus runs transversely across the sole, it pulls the medial and
lateral margins of the sole closer together, thus maintaining the transverse arches by acting as a
tiebeam.
Longitudinal Arch:
Due to its route around the cubital bone, it helps maintain the Longitudinal arch by supporting the
cubital bone from below by its pulley like action.
Q: Why Medial Meniscus Tear is more common than Lateral Meniscus Tear.
Injuries to medial menisci are quite common by the twisting strain in a slightly flexed knee (eg.
kicking a football). The menisci get separated from the joint capsule or may be torn longitudinally or
transversely.
Menisci are two crescent-shaped intra-articular discs made of fibrocartilage. They have thick
peripheral border and thin inner border. They deepen the articular surfaces of the tibia.

Medial Meniscus is more prone to injury because of the following reasons:

• It is firmly attached to the tibial collateral ligament and thus its mobility is restricted and can't
adapt to rapid movements. On the other hand, Lateral Meniscus is not attached to Fibular
Collateral Ligament and enjoys freedom of movement.
• The lateral meniscus is protected by medial fibers of popliteus which attach to lateral border
and pulls it out during initiation of knee flexion.
• It is exposed to greater excursions in rotation of knee.
 Q: Fractured Neck of Femur Causes Avascular Necrosis of Head of femur.
The head of femur’s Main arterial supply is from retinacular arteries which arise from the medial
circumflex femoral artery. These retinacular arteries run along the retinacular fibers of femur
can get injured in intracapsular fracture of neck of femur, leading to avascular necrosis of the
head.

Q: Why all hamstrings are not true hamstrings?

CHARACTERISTICS OF HAMSTRINGS:
• All arise from ischial tuberosity.
• All are inserted into one of the bones of the leg
• All are supplied by TIBIAL PART OF SCIATIC NERVE.
• All are FLEXORS of the knee and EXTENSORS of hip.
Although there are 4 hamstrings
1. Adductor Magnus (ischial head) – AM
2. Biceps Femoris (Long Head) – BF
3. Semimembranosus – SM
4. Semitendinosus – ST
The AM and BF are not considered true hamstrings because;
The BF origin was initially at the ileum. However, it shifted to the ischial tuberosity during evolution
due to the bipedal locomotion of ancestors. The vestigial remain is still present as the
Sacrotuberous ligament.
The AM insertion was initially at the upper lateral side of the tibia. However, it shifted to the
adductor tubercle during evolution and the vestigial ligament is called the Tibial Collateral
Ligament.
Q: Ossification of the lower end of the femur is of medicolegal importance.
Presence of ossification center in the lower femur and even upper end of tibia and fibula in a newly
born child found dead indicates that the child was viable, i.e., it was capable of independent
existence.

This is because even though the lower end of femur is a primary ossification center, it starts to
ossify only during the 9th month of IUL or just after delivery. This can be used to determine the
maturity of fetus in case of dispute.

Q: Why is soleus called the peripheral heart?

The muscles of the calf play an important role in circulation. Contractions of these muscles help in
the venous return from the lower limb.
The soleus is particularly important in this respect.
There is a venous plexus present in the muscle. When the muscle contracts the blood in these
plexus is pumped into the deep veins. When it relaxes, it sucks the blood from the superficial veins
through the perforator veins. This helps in flowing of blood from the veins into the heart against
gravity.
Q: Trendelenburg’s sign.
Normally when the body weight is supported on one limb, the gluteus Medius and MInimus of the
supported side raise the opposite and unsupported side of the pelvis. However, if the abductor
mechanism is defective, the unsupported side of the pelvis drops, and this is known as a positive
Trendelenburg’s sign.
Occurs due to Paralysis of gluteus Medius and Minimus muscle of the opposite side.
The person walks with a lurching gait if only one side is paralyzed and a waddling gait if both sides
are paralyzed.

Supported Side

Testing: Gluteus medius and gluteus minimus can be tested together by doing internal rotation of
thigh against resistance