Bones of the Lower Limb PDF (Anatomy 1 2019/2020)
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Uploaded by ExcitedMood2873
UPJŠ Košice
2019
GM
Jana Vecanová, PhD.
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Summary
These lecture notes cover the anatomy of the bones of the lower limb, including the hip bone (os coxae), femur, patella, tibia, fibula, and foot. Detailed information about each bone's structure and function is provided.
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Lecture No. 8 – GM – Anatomy 1 – AY 2019/2020 Bones of the Lower Limb MD Jana Vecanová, PhD. The lower limb (extremity) is specialized to support body weight, for locomotion (ability to move from one place to another), and to maintain balance. BONE...
Lecture No. 8 – GM – Anatomy 1 – AY 2019/2020 Bones of the Lower Limb MD Jana Vecanová, PhD. The lower limb (extremity) is specialized to support body weight, for locomotion (ability to move from one place to another), and to maintain balance. BONES OF LOWER LIMB: - hip bone (os coxae) - forms the bony connection between the trunk and lower limb, forms pelvic girdle (pelvic girdle also makes up the skeleton of the trunk) Bones of free lower limb: - femur (thigh bone) - patella (knee cap) – covers the anterior surface of the knee - tibia (shin bone), fibula (calf bone)– bones of the leg (leg in latin - crus) - foot - contains the tarsus (which connects the ankle and foot) metatarsus, and phalanges (toe bones) Hip (coxal) bone forms pelvic girdle - each mature hip bone is formed by the fusion of three primary bones: ilium, ischium, pubis - at puberty these bones are still separated by a triradiate cartilage (fusion of bones is complete between the 20th and 25 years of age) Although the bony components are rigidly fused, their names are still used in adults to describe the three parts of the hip bone. Normal radiograph of the pelvis in an 11th month child. Throughout childhood, the pelvis is made of smaller bones that eventually fuse during adulthood to form a more rigid pelvis. Each of the coxal bones begins as three separate bones: the ilium, ischium, and pubis.... ilium ossification center in head of femur pubis ischium Pelvic girdle and related joints, demonstrating transfer of weight. The arrangement of the lower limb bones of bipeds is compared to that of quadrupeds. The diagonal disposition of the femur recenters support directly inferior to the trunk to make bipedal standing more efficient. In quadrupeds, the femurs are vertical and the knees are apart, with the trunk mass suspended between the limbs. A. The weight of the upper body, transmitted centrally through the vertebral column (1), is divided and directed laterally by means of the bony arch formed by the sacrum and ilia (2). Thick portions of the ilia transfer the weight to the femurs (3). The pubic rami form braces that help maintain the integrity of the arch (4) Posterior and lateral view Lunate surface Acetabulum of acetabulum Limbus of acetabulum Acetabulum – cuplike cavity (socket) on the lateral aspect of the hip bone - for articulation with the head of the femur (ilium forms the superior part of the acetabulum, ischium forms posterior part of acetabulum, Pubis forms anterior part of acetabulum) Acetabular fossa - lunate surface – articular area (is covered by articular cartilage) - acetabular fossa – non- articular area, in the center of acetabulum, is covered by fatty tissue - acetabular notch – opens the acetabulum inferiorly - limbus of the acetabulum (acetabular rim or margin or labrum) Obturator foramen – is bordered by the ischium and pubis Nice tutorial video – Hip bone: https://www.youtube.com/watch?v=3v5AsAESg1Q Acetabular notch is crossed by the transverse acetabular ligament – contributes to the stability of the joint - part of load-bearing surface for femoral head THE ILIUM Ala of ilium Body – forms part of acetabulum Body of ilium Ala (wing-like portion) – upper flattened part of ilium - iliac crest – superior border of the ala iliac fossa THE ILIUM gluteal surface Surfaces of the ala (wing): Anterior (internal) surface is called iliac fossa (forms depression) Posterior (external) surface – is gluteal surface faces to the gluteal region (greek Gloutos, buttocks) Sacropelvic surface faces to the sacrum iliac fossa THE ILIUM Ala of ilium Sacropelvic surface of the ala contains: Body of ilium auricular surface - ear shaped articular area for sacrum (latin. auricula, a little ear) iliac tuberosity – rougher area, superior to auricular surface for attachment of ligaments iliac fossa THE ILIUM - 4 iliac spines: 2 Anteriorly provide attachment for ligaments and tendons anterior superior iliac spine (ASIS) – important landmark of surface anatomy anterior inferior iliac spine 2 Posteriorly posterior superior iliac spine (PSIS) posterior inferior iliac spine greater sciatic notch – lies beneath post. inf. iliac spine THE ILIUM posterior inferior iliac spine marks the superior end of the greater sciatic notch iliac fossa THE ILIUM - behind the iliac fossa is the sacropelvic surface (medial surface): auricular surface – is a large irregular ear or L-shaped facet that articulates with the sacrum sacropelvic surface iliac tuberosity - is a large rough area below dorsal segment of iliac crest - iliopubic eminence – a rounded elevation on the superior surface of the hip bone at the junction of the ilium and the superior ramus of the pubis. Iliopubic eminence 3 gluteal lines (posterior, anterior, inferior) on gluteal surface of ala – external surface of the wing gluteal surface of ilium, for attachments of gluteal muscles Pelvic inlet Arcuate line of ilium - smooth rounded border on the internal surface of the ilium - is immediately inferior to the iliac fossa - forms part of the border of the pelvic inlet (border between greater pelvis and lesser pelvis) greater pelvis is the space between iliac wings lesser pelvis (true pelvis) – is space enclosed by pubic symphysis and rami of pubes, by the sacrum and coccyx, and laterally by ischium, and the part of ilium below the arcuate line Iliac tubercle – the widest point of the iliac crest - lies 5-6 cm posterior to ASIS Posterior view THE ISCHIUM - forms the lower and back part of the hip bone 2 main parts: - body (corpus) – forms the postero-inferior part of the acetabulum - ramus – L shaped, joins the inferior ramus of pubis ---------------------------------------------------------------- ischial spine – provides ligamentous attachment ischial tuberosity (tuber) – the body´s weight rests on this tuberosity when sitting - provides tendinous attachment for posterior thigh muscles THE ISCHIUM greater sciatic notch – lies superior to the ischial spine lesser sciatic notch – indentation inferior to the spine THE PUBIS (most anterior portion of the hip bone) - body – contributes to the formation of anterior part of acetabulum - superior ramus - inferior ramus - the two rami enclose part of the obturator foramen body of pubis superior pubic ramus inferior pubic ramus THE PUBIS The superior ramus bears: - pubic tubercle – lies on the medial portion of the superior pubic ramus - pubic crest – lies medialy to the pubic tubercle provides attachment for abdominal muscles Pubic tubercle Pubic crest - obturator groove – lies inferiorly on the superior pubic ramus Anterior superior iliac spine, pubic tubercle (palpable structures) - sites of attachments of inguinal ligament - inguinal ligament demarcates inferior border of abdominal muscles The mid-inguinal point, halfway between the anterior superior iliac spine and the pubic symphysis, is the landmark for the femoral artery. mid-inguinal point ASIS Iliac crest serves for attachment of abdominal muscles Pubic tubercle Obturator foramen is created by the ischium and pubis bones. - is almost completely closed by obturator membrane (provides surface area for muscle attachment) Obturator canal - small opening in the superior part of obturator foramen is passageway for the obturator artery, obturator vein and obturator nerve. Obturator crest – sharp margin on the superior ramus of pubis - lies on on inferior surface of the superior ramus - gives attachment to the pubofemoral ligament Symphysial surface of the pubis – contributes to formation of pubic symphysis Symphysial surface pubic symphysis Pubic pecten (pectineal line) lies on posterior margin of the superior pubic ramus - forms part of the pelvic brim - pelvic brim (linea terminalis, terminal line) - border between the lesser and greater pelvis - border of pelvic inlet = line passing through the prominence of the sacrum, the arcuate line and pubic pecten, and the upper margin of the pubic symphysis = pelvic inlet Arcuate line of ilium = pelvic inlet Pubic pecten Major features of the AP (anteroposterior) radiograph of the pelvis female pelvis versus male pelvis A male pelvis is smaller and narrower in nature which is designed to support a heavy body build and a stronger muscle structure while a female pelvis is wider and roomier and mainly serves for the purpose of childbearing. ANATOMICAL POSITION OF HIP BONE ASIS and pubic tubercle lie in the same coronal plane pelvic inlet is more vertical than horizontal Perfect tutorial video- Hip bone: https://www.youtube.com/watch?v=Bz0IOq3mJDI FEMUR Proximal end: head, neck, greater and lesser trochanters head articulates with acetabulum to form hip joint fovea - small depression in the center of the head neck – connects the head to the shaft (makes an angle of about 125° with the long axis of the shaft = neck-shaft angle = angle of inclination) greater trochanter large eminences at the junction of the neck and lesser trochanter the shaft intertrochanteric line – connects the two trochanters anteriorly intertrochanteric crest – at the posterior surface - on the crest lies the quadrate tubercle trochanteric fossa – pit-like depression below the greater trochanter Fovea of the head of femur – for attachment of ligament of head of femur - provides some mechanical stability to the hip joint Clinical note common injuries in elderly people the cause is often related to osteoporosis (reduced bone mineral density) and associated with a fall significant trauma (e.g. motor vehicle collisions) in younger patients occurence of complications related to nonunion and avascular necrosis (osteonecrosis) increases from type I to IV hip fractures increase the risk of death and major morbidity in the elderly Surgical treatment - internal fixation can be performed with crossed screw-nails. FEMUR - Shaft: linea aspera – lies posteriorly - two-lipped roughened line - medial lip, lateral lip - here are attached muscles and intermuscular septa - gluteal tuberosity – proximal continuation of the lateral lip (if the tuberosity is developed very strongly → third trochanter) pectineal line – ridge descending from the lesser trochanter medial and lateral supracondylar line – distal continuations of medial and lateral lips of the linea aspera popliteal surface – triangle betwen the two lines Distal end of the femur Posteriorly: medial and lateral condyles medial and lateral epicondyles – provide proximal attachment for the medial and lateral collateral ligaments of the knee joint adductor tubercle – elevation above the medial condyle intercondylar fossa – depression posteriorly intercondylar line Anteriorly: Pohľad spredu Pohľad zozadu patellar surface – between condyles anteriorly Palpable structures of the hip bone and femur – surface anatomy Identify palpable structures on your own body L4 Iliac crest can be felt along its entire length from anterior superior iliac spine to posterior superior iliac spine. Its highest point lies opposite body of fourth lumbar vertebra (L4). Posterior superior iliac spine is at level of S2 (second sacral vertebra). Clinical note Causes: being hit by a car as a pedestrian falls from heights Symptoms: severe pain. Patient is not be able to put weight on the injured leg, and it may look deformed — shorter than the other leg and no longer straight. Recovery: Most femoral shaft fractures take 4 to 6 months to completely heal. X-rays: Treatment: Using intramedullary nails or metal plates attached to the outer surface of the bone. Plates and screws are often used when intramedullary nailing may not be possible, such as for fractures that extend into either the hip or knee joints. Femur, perfect tutorial video: https://www.youtube.com/watch?v=oi0cOvuhsa8 Patella - largest sesamoid bone of the human body - develops within the tendon of the quadriceps femoris muscle - apex – lies inferiorly - base – facing proximally - anterior surface - rough - articular surface – is divided into a lateral and medial facet by a vertical ledge Anterior view Posterior view Bones of the Leg: Tibia, Fibula - tibia articulates with condyles of femur superiorly and with talus inferiorly - fibula mainly functions as attachment for muscles is also important for stability of ankle joint ----------------------------------------------------------------- - shafts of tibia and fibula are connected by interosseous membrane - tibia is located on the anteromedial side of the leg Anterior view Posterior view Tibia shaft, proximal and distal ends --------------------------------------------------------- Proximal end: medial and lateral condyles superior articular surface (articulates with condyles of femur) intercondylar eminence (elevation in the middle, is subdivided into a medial and lateral intercondylar tubercle) anterior and posterior intercondylar area (lie in front of and behind the eminence) articular facet for the head of the fibula tibial tuberosity Shaft: three borders (anterior, medial, interosseous) three surfaces (medial, lateral, posterior) soleal line – lies proximally on posterior surface Tibia, superior view Lateral intercondylar tubercle Intercondylar Medial intercondylar Posterior tubercle eminence intercondylar area intercondylar eminence - elevation in the middle, is subdivided into a medial and lateral Anterior intercondylar tubercle intercondylar area - fit into the intercondylar fossa between the femoral condyles Right lower limb intercondylar eminence provide attachment for the menisci and principal ligaments of the knee Tibial tuberosity – site of attachment of quadriceps femoris muscle by means of patellar ligament facet for the fibular head – lies posterolaterally - on inferior aspect of the lateral condyle - for proximal tibio-fibular articulation (synovial joint) Posterior view, right leg here is distal tibio-fibular syndesmosis Soleal line – lies on posterior surface of tibia, origin of soleus muscle (soleus is part of triceps surae, it is deep head of triceps surae) Tibia dx. Anterior view Posterior view Tibia – distal end Fibular notch Posterior view, Anterior view, right leg inferior articular surface - medial malleolus - bony prominence that forms medial ankle (with its malleolar articular surface the for talus) - malleolar groove – on posterior surface of the tibia - inferior articular surface – articulates with the talus - fibular notch – lies on lateral surface of the tibia, wide depression for a fibrous joint (syndesmotic connection) with the fibula Ankle joint (talocrural joint) - distal ends of tibia and fibula are firmly connected in syndesmosis - articular socket is formed by inferior articular surface of tibia, medial malleolar surface of tibia, lateral malleolar surface of fibula - articular head: talus FIBULA - slender lateral bone of the leg - takes no part in the articulation at the knee joint - takes no part in the transmission of body weight - provides attachments for muscles - two extremities, shaft Head – with its articular facet for articulation with the lateral condyle of the tibia and a small apex of the fibular head Neck Shaft - has four borders and four surfaces - interosseous border gives attachment to the interosseous membrane Lateral malleolus – distally - with a facet for articulation with the talus and on its inner surface - malleolar fossa – behind the articular facet (for attachment of ligaments) TIBIA, FIBULA Please, do not learn surfaces and margins of fibular shaft Fibula video https://www.youtube.com/watch?v=HTSYQhuoaiw Major features of radiographs of the knee The patella is often not clearly seen on this view. - AP (anteroposterior) radiograph AP radiograph of left knee Structures labeled on are: A - femur K - patella lateral epicondyle (B) femorotibial joint (C) fibular head (D) fibular neck (E) tibia (F), lateral intercondylar tubercle (G) medial intercondylar tubercle (H) medial femoral condyle (I) medial femoral epicondyle (J) patellar surface of femur (arrow). Lateral radiograph of the knee (bočná snímka) Femoral condyles overlap each other. 21-year-old Male Palpable structures around the knee - find on your own body patella Head of the fibula serves for attachment of biceps femoris muscle. Right leg Left leg BONES OF FOOT Sesamoid bone Tarsal bones Talus Calcaneus (heel bone) Navicular bone (boat –shaped bone) Cuneiform bones -3 Cuboid bone Metatarsal bones (base, shaft, head - distally) Phalanges - proximal, middle distal (base, shaft, head, tuberosity of the distal phalanx) *sesamoid bones – - may be near the metatarsophalangeal joints - regularly in the region of the head of the first metatarsal TALUS - articulates above at the ankle joint with the tibia and fibula, below with the calcaneus, and in front with the navicular bone - body (corpus) – carries the trochlea – articulates with the distal end of the tibia and fibula - neck (collum) – lies posterior to the head - head (caput) – carries the navicular articular surface - posterior talar process - lateral talar process Trochlea tali Navicular articular surface lateral talar process TALUS Trochlea tali - Trochlea – has 3 articular facets: medial malleolar facet (for articulation with the medial malleolus of tibia) superior facet lateral malleolar facet (for articulation with the lateral malleolus of fibula) Groove for flexor hallucis longus tendon - posterior talar process has medial and lateral tubercles - separated by groove for the flexor hallucis longus tendon On the inferior surface of the talus: - 3 calcaneal articular surfaces anterior, middle, posterior - talar sulcus – lies posterior to the middle calcaneal articular surface CALCANEUS upper surface has 3 talar articular surfaces (anterior, middle, posterior) calcaneal sulcus – lies posterior to the middle articular surface Tarsal sinus – is space between talus and calcaneus formed by calcaneal sulcus and talar sulcus together Tarsal sinus CALCANEUS Tuber calcanei – large process - for insertion of Achilles tendon Medial surface of the bone - sustentaculum tali – shelflike process - assists in the support of the talus - inferior to the sustentaculum is – groove for the tendon of the flexor hallucis longus groove for the tendon of the flexor hallucis longus Tuber calcanei groove for the tendon of the flexor hallucis longus CALCANEUS Lateral surface of the bone: - peroneal (fibular) trochlea – small bony tubercle, under the trochlea lies groove for the tendon of the peroneus (fibularis) longus Anterior end of the bone: - surface for the articulation with the cuboid bone peroneal trochlea groove for the tendon of the peroneus longus Tuber calcanei - has two processes on its plantar surface: medial process lateral process Calcaneus - the largest bone of the foot - forms the prominence of the heel - transmits most of the body weight from the talus to the ground lateral process medial process NAVICULAR BONE - tuberosity of the navicular can be seen and felt on the medial border of the foot CUNEIFORM BONES – three wedge-shaped bones articulate proximally with the navicular bone and distally with the first three metatarsal bones Medial – the largest Intermediate – the smallest Lateral - III. Tuberosity of the navicular II. I. CUBOID BONE distally – joint surfaces for the fourth and fifth metatarsals CUBOID BONE on inferior surface: groove for the tendon of the peroneus (fibularis) longus tuberosity of the cuboid (lies proximally from the groove) METATARSAL BONES tuberosity of first metetarsal bone tuberosity of fifth metatarsal bone - palpable structure Palpable / visible bony structures on foot – surface anatomy Tuberosity of fifth metatarsal bone Tuberosity of navicular bone Tuberosity of navicular bone Palpation of os naviculare Anteroposterior radiograph of the Ankle Radiograph of the Ankle (ankle mortise, malleolar mortise) The radiograph shows the radiolucent joint spaces separating the body of talus from the lateral malleolus, tibial plafond and medial malleolus. * The inferiorly directed articular surface at the distal end of tibia is called the tibial plafond, or ceiling, of the ankle joint. On the left image is fracture of the lateral malleolus below the level of the syndesmosis. This ankle is stable. On the right image there is an unstable fracture. There is a lateral fracture and on the medial side there is a rupture of the collateral ligament allowing the talus to dislocate laterally. Following osteosynthesis in unstable fractures is obvious. Placement of a syndesmotic screw to stabilize the ankle joint. Foot – lateral radiograph Example radiograph of foot of 15-year-old child showing the epiphyseal plates of the phalanges and metatarsal bones Epiphyseal plates (growth plates) Epiphyseal plate (physis) - it is a vital growth area cuneiforms near the end of a long bone, which later fuses with the main bone through ossification. It is a hyaline cartilage plate in the metaphysis at each end of a long bone. navicular bone cuboid calcaneus talus Radiogram of distal tibia and fibula showing two Epiphyseal plates at distal femur, proximal tibia and fibula epiphyseal plates. Pictures were presented from atlases: Netter: Atlas of human anatomy, 6th Ed., Elsevier 2014 Schuenke, Schulte, Schumacher: Atlas of Anatomy, General anatomy and musculoskeletal system, 2nd Ed., Thieme 2014 Moore: Clinically Oriented Anatomy, 8th Ed., Wolters Kluwer 2018