Vertebral Anatomy and Injuries ED Clinics PDF

Bones and joints Atlas Axis Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Cervical part of the verterbral column X - Ray Vertebral fractures Vertebral fractures...

Bones and joints Atlas Axis Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Cervical part of the verterbral column X - Ray Vertebral fractures Vertebral fractures Dens of axis fracture Type II Vertebral fractures Hangman fracture Cervical spine Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier 1st and 2nd cervical vertebra Vertebral fractures Jefferson fracture Thoracic vertebra Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Thoracic vertebras Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Lumbar vertebra Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Lumbar vertebras Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Comparison of the vertebras Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Sacral bone – dorsal surface Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Sacral bone – ventral surface Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Sacral bone – superior and lateral surface Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier © 2005 Elsevier Coccygeal bone - Coccyx Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Joints of the vertebral column - Synchondroses - intervertebral discs -Syndesmoses – - anterior and posterior longitudinal ligament - flava ligaments - intertransverse ligament - interspinous ligaments - supraspinous ligament - Synostoses – sacral bone, coccygeal bone - Synovial joints – intervertebral joints, Intervertebral foramen Synovial joints of the vertebral column Atlanto – axial joint - Median -- Anterior and -- Posterior - Lateral Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Synovial joints of the vertebral column Ligaments of the atlantoaxial joint: - Cruciform ligament ; -- transverse ligament of the atlas; -- longitudinal fascicles; - Alar ligaments; - Ligament of the apex of the dens; - Tectorial membrane; Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Syndesmoses of the vertebral column - Anterior longitudinal ligament - Posterior longitudinal ligament Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Syndesmoses of the vertebral column Flava ligaments Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Syndesmoses of the vertebral column Intertransverse ligaments Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Syndesmoses of the vertebral column Interspinous and supraspinous ligaments Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Syndesmoses of the vertebral column Nuchal ligament Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Osteoporosis Osteoarthritis Vertebral injuries Vertebral injuries Vertebral injuries Vertebral injuries Chronic backpain Chronic backpain Associated with the Zygapophyseal (Facet) Joints. -Degeneration of the articular cartilage; - Osteophyte (bony outgrowth) overgrowth of the facet articular processes. Vertebral injuries Neck strain is often just called wiplash. Although it's usually associated with car accidents, any impact or blow that causes your head to jerk forward or backward can cause neck strain. The sudden force stretches and tears the muscles and tendons in your neck. Neck strain afflicts many amateur and professional athletes. People who play contact sports like football are especially prone to neck strain. Neck strains are often confused with neck sprains. They're a bit different. Neck strains are caused by damage to the muscle or the tendons, bands of tissue that connect muscles to bones. Neck sprains are caused by tearing of the ligaments, the tissues that connect the bones to each other. Vertebral injuries Scoliosis is not a disease, but rather it is a term used to describe any abnormal, sideways curvature of the spine. Viewed from the back, a typical spine is straight. When scoliosis occurs, the spine can curve in one of three ways: The spine curves to the side as a single curve to the left (shaped like the letter C), called levoscoliosis The spine curves to the side as a single curve to the right (shaped like a backwards letter C), called dextroscoliosis The spine has two curves (shaped like the letter S). Idiopathic Scoliosis The most common form of scoliosis is idiopathic scoliosis, which occurs in approximately 2% of the population. The term idiopathic means a condition or disease with no known cause. Idiopathic scoliosis is by far the most common cause of scoliosis in children. (Degenerative scoliosis is the most common form of scoliosis in adults.) Idiopathic scoliosis rarely causes pain, and in most cases the curve is minor enough to be considered an asymmetry and does not require any treatment. However, once scoliosis is detected it should be closely monitored by a medical professional in the event that the curve progresses and needs treatment. Vertebral injuries Vertebral injuries Interverteral joints Interverteral joints Interverteral joints Vertebral column Ankylosing spondylitis Lumbar puncture Level L4 – L5 During lumbar puncture a needle is passed though the interlaminar space while the vertebral column is flexed. The needle passes through the following layers: -Skin - Superficial fascia - Deep fascia - supraspinous ligament - interspinous ligament - interlaminar space - epidural space - dura - arachnoid - subarachnoid space Epidural anesthesia L3 – L4  Thorax - Manubrium - Body -Xiphoid process Sternal angle – between manubrium and body of the sternum - Manubriosternal joint – synchondrosis - Xiphosternal joint - synchondrosis Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Thorax Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Thorax Sternocostal joints – between true ribs and sternum directly by the costal cartilages Costochondral joints – between bony rib and costal cartilage; Interchondral joints – between cartilage of the last true rib and cartilages of the false ribs; Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Thorax Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Thorax Costovertebral joints 1. Joint of the head of the rib - Head of the rib - Costal facets superior and inferior - Intervertebral disc Ligaments: - Radiate ligament of the head of the rib - Intraarticular ligament of the head of the rib Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Thorax 2. Costotransverse joint – ball and socket - Costal tubercle - costal facet of the transverse process Ligaments - Costotransverse ligament - superior costotransverse ligament - lateral costotransverse ligament; Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Thorax Fifth rib (V) is connected to: - Inferior costal facet of Th4 - superior costal facet of Th5 - costal facet of the transverse process of Th5 Downloaded from: StudentConsult (on 1 October 2012 09:03 PM) © 2005 Elsevier Ribs fractures puncture Rib fractures Upper limb girdle Clavicle -Acromial end -- acromial articular surface -- conoid tubercle -- trapezoid line -Body -- subclavian line - Sternal end -- sternal articular surface -- costoclavicular impression Upper limb girdle Scapula Angles: - Superior Surfaces: -Inferior - Lateral -Costal (anterior) -- Subscapular fossa Margins: -- Muscular lines - Superior -- Coracoid process - Medial - Lateral - Dorsal (posterior) -- Spine of the scapula --- Acromion -- Supraspinatus fossa -- Infraspinatus fossa s Upper limb girdle Sternoclavicular joint – irregular, ball and socket - Clavicular notch - sternal end of clavicle - articular disc Ligaments -Sternoclavical ligament -- anterior and posterior - Interclavicular ligament Upper limb girdle Acromioclavicular joint – irregular, ball and socket -Acromion - Acromial end of clavicle Ligaments - Acromioclavicular ligament - coracoclavicular ligament -- conoid ligament -- trapezoid ligament Upper limb girdle Movements: - Elevation 40 degrees - Depression 10 degrees - Protrusion 25 degrees - Retraction 25 degrees Upper limb Humerus Shoulder joint Ball and socket, spheroid - Head of the humerus - Glenoid cavity - glenoid lip Shoulder joint Capsule, ligaments, and joint cavity of the right shoulder -Glenohumeral ligaments -- superior -- middle -- inferior -Coracohumeral ligament -Coracoacromial ligament – „humeral fornix” Shoulder joint Movements of the shoulder joint a. Flexion and extension b. Anteversion and retroversion of the arm raised to 90 degree abduction c. Abduction and adduction about sagittal axis. d-f. internal and external rotation of the arm about the longitudinal axis of the humerus. Shoulder joint Rotator cuff muscles: -Supraspinatus m. - infraspinatus m. - teres minor m. - subscapularis m. Their tendons strenghten the glenohumeral joint they may become torn or inflamed. The most commonly affected is supraspinatus muscle. Shoulder joint Shoulder joint Humeral head dislocation Typically occurs through inferior portion of the joint capsule, where it is slackest and it is not reinforced by a rotator cuff tendon. After inferior dislocation, the humeral head is pulled superiorly and comes to lie anterior to the glenohumeral joint. Dislocation may injure the axillary or radial nerve. Anterior dislocation Shoulder joint Dislocation of the biceps tendo MR  Shoulder joint Humeral surgical neck fracture Around surgical neck of the humerus passes axillary nerve accompanied by posterior circumflex humeral artery. Fracture in this area can damage both of those structures. Humeral surgical neck fracture  Shoulder joint Mid – shaft (Radial Groove) Humeral Fracture The radial nerve goes along the humeral shaft together with deep brachial artery. After mid shaft humeral fracture both can be damaged. Mid-shaft (radial groove) humeral fracture Elbow joint The articulating skeletal elements of the right elbow joint Humeroradial joint - Capitulum - Fovea of the head of radius Humeroulnar joint -Trochlea - trochlear notch Radioulnar proximal joint -Circumference of the head of radius - radial notch Elbow joint The capsule and ligaments of the elbow joint in extension, Ligaments of the elbow joint: - Radial collateral ligament - Ulnar collateral ligament - Annular ligament of the head of radius Elbow joint The capsule and ligaments of the right elbow joint in 90 degree flexion Elbow joint Elbow joint  Elbow joint Medial epicondyle humeral fracture The ulnar nerve goes posteriorly around medial epicondyle of the humerus After medial epicondyle fracture ulnar nerve can be lacerated. Medial epicondyle humeral fracture Radioulnar joints Ligaments and axes for pronation and supination in the proximal and distal radioulnar joints. - Interosseus membrane; - Oblique cord; Elbow joint and radioulnar joints joints Range of motion in the humeroradial and humeroulnar joints of the elbow Range of pronation and supination of the right hand a. Supination (the radius and ulna are parallel to each other b. Pronation (the radius crosses over the ulna) c. Supination of the hand with the elbow flexed , viewed from the front d. Pronation of the hand with the elbow flexed , viewedfrom the front Radiocarpal joint Radiocarpal joint structure Radiocarpal joint Elipsoid Joint Radiocarpal joint movements -Adduction - Abduction - flexion - extension - circumduction Wrist joint ligaments - Radiocarpal collateral ligament; - Ulnocarpal collateral ligament; - Radiocarpal palmar ligament; - Ulnocarpal palmar ligament; - Radiocarpal dorsal ligament; - Ulnocarpal dorsal ligament; Wrist Flexor retinaculum (transverse carpal ligament) and carpal tunnel Boundaries: - Anterior - flexor retinaculum - Posterior – carpal bones Wrist The carpal tunnel transmits 9 tendons: - 4 tendons of the flexor digitorum superficialis - 4 tendons of the flexor digitorum profundus - Tendo of the flexor pollicis longus - median nerve Wrist The carpal tunnel syndrom Entrapment of the median nerve by the condition that reduces the space results in carpal tunnel syndrom providing to median nerve injury (palsy). Wrist Wrist bones fractures The scaphoid is the most frequently fractured of the carpal bones. It may separate the proximal head of the scaphoid bone from blood supply resulting in avascular necrosis of head. Wrist Wrist bones dislocation The lunate bone is the most commonly dislocated carpal bone. After this dislocation it may compress median nerve causing carpal tunnel syndrom. Wrist Wrist bones fractures Fracture of the hook of hamate A Fall on the outstreched hand may fracture the hook of the hamate, which can damage the ulnar nerve as it passes into the hand. Hand Joints and ligaments of hand Hand The joint capsules, ligaments and digital tendon sheath of fingers.  Hand Axes of motion of the carpometacarpal joint of the thumb. Articulating surfaces of the carpometacarpal joint of the thumb Hand Movements in the carpometacarpal joint of the thumb: a. The neutral (zero-degree) position. b. Axes of motion in the carpometacarpal joint of the thumb. c. Adduction d. Abduction e. Flexion f. Extension g. Opposition h. Axis for opposition of the thumb. Hand Movements of the radiocarpal and midcarpal joints: a. Palmar flexion and dorsal extension about a transverse axis. b. Radial and vulnar deviation about a dorsopalmar axis. Hand Range of motion of the finger joints. a. Flexion in the distal interphalangeal joint (DIP). b. Flexion in the proximal interphalangeal joint (PIP). c. Flexion in the metacarpal joint (MCP). d. Extension in the distal interphalangeal joint (DIP). e. Extension in the metacarpophalangeal joint (MCP). f. Abduction and adduction in the metacarpophalangeal joints. Hip joint Articular surfaces Head of femur Lunate surface Accessory elements Glenoid lip (labrum) Intracapsular ligaments -Ligament of the head of femur - transverse acetabular lig. - zona orbicularis Hip joint Extracapsular ligaments: Iliofemoral lig. Ischiofemoral lig. Pubofemoral lig. Hip joint Movements of hip joint -Flexion - extension - adduction -Abduction - circumduction (limited) - lateral rotation - medial rotation Ball and socket – cotyloid joint Hip joint Most of the blood supply to the head of the femur (arising mostly from the medial femoral circumflex artery) ascends along the neck of femur. Fracture of the femoral neck can compromise this blood supply and lead to avascular necrosis of the head of femur. Hip joint  Hip joint Hip endoprosthesis Pelvic fracture Hip joint Knee joint Largest synovial joint of the human body Articular surfaces : - Two femoral condyles -Superior articular surface of tibia - patella Knee joint Accessory elements: - Lateral meniscus (more mobile) LM - medial meniscus MM Knee joint Knee joint Accessory elements: Intracapsular ligaments -Anterior cruciate ligament ACL - posterior cruciate ligament PCL - meniscofemoral ligaments (anterior and posterior - transverse ligament of the knee Knee joint Accessory elements: Extracapsular ligaments: -Fibular collateral ligament - tibial collateral ligament Knee joint Accessory elements: Extracapsular ligaments: -arcuate popliteal ligament - oblique popliteal ligament - patellar ligament - lateral patellar retinaculum - medial patellar retinaculum Knee joint Hinge modified joint Movements: - Flexion -Extension - medial rotation 10 degree - lateral rotation 30 degree Knee joint Knee joint Knee joint Knee joint Tibial collateral ligament is the most frequently torn ligament at the knee, following lateral trauma of the knee. Knee joint Anterior cruciate ligament is also the most frequent injured structure of the knee, its weaker than posterior cruciate ligament. The tests for the integrity of the anterior and posterior cruciate ligaments are the anterior and posterior drawer signs. Knee joint Anterior cruciate ligament is also the most frequent injured structure of the knee, its weaker than posterior cruciate ligament. The tests for the integrity of the anterior and posterior cruciate ligaments are the anterior and posterior drawer signs. Knee joint Unhappy triad: The three commonly injured structures at the knee are: -Tibial collateral ligament - the medial meniscus - ACL Results from the blow to the lateral aspect of the knee with the foot on the ground. Patients with a medial meniscus tear have pain when the leg is medially rotated at the knee. Ankle joint Articular surfaces: -Inferior articular surface of tibia - articular surface of the medial and lateral malleolus - lateral and medial malleolar Surfacee - superior articular surface of the trochlea of talus Ankle joint Hinge joint Movements: -Flexion - extension Ankle joint Ligaments: -Deltoid ligament - anterior tibiotalar part - posterior tibiotalar part - tibionavicular part - tibiocalcaneal part - Lateral ligament - anterior talofibular ligament - posterior talofibular ligament - calcaneofibular ligament Ankle joint Ankle joint Talocalcaneal joint Subtalar joint Articular surfaces: - Posterior, middle and anterior talar articular surface of calcaneus - Posterior, middle and anterior calcaneal articular surface of talus Type of joint: - elipsoid Movements: -Rotation Ligaments: -Anterior talocalcaneal ligament - posterior talocalcaneal ligament - lateral talocalcaneal ligament - medial talocalcaneal ligament - interosseus talocalcaneal ligament Talocalcaneonavicular joint Talocalcaneonavicular joint: -Navicular articular surface of talus - talar articular surface of navicular bone - plantar calcaneonavicular ligament - calcaneonavicular part of bifurcate ligament Ball and socket joint Movements: Eversion and inversion Talocalcaneal joint Talocalcaneal joint An inversion injury may fracture the medial malleolus and tear ligaments anchoring the lateral malleolus to the tarsal bones. The ring may be disrupted not only by damage to the bones (which produces fractures), but also by damage to the ligaments. When a fracture is noted on a plain radiograph, the physician must always be aware that there may also be appreciable ligamentous disruption. Calcaneocuboid joint Calcaneocuboid joint: -Cuboid articular surface of the calcaneus - calcaneal articular surface of the cuboid bone Plain joint Ligaments: -Plantar calcaneocuboid ligament - calcaneocuboid part of the bifurcate ligament Tarsal joints Transverse tarsal joint - Talocalcaneonavicular joint - Calcaneocuboid joint Tarsal joints: -Cuneonavicular joint Cuneonavicular ligament Cuneonavicular planar ligament Cuneonavicular interosseus ligament Tarsal joints Intercuneiform joints - Intercuneiform ligament - intercuneiform plantar ligament - intercuneiform interosseus ligament Cuneocuboid joint - Cuneocubid ligament -Cuneocubid plantar ligament -Cuneocubid interosseus ligament Cubonavicular joint - Cubonavicular ligament - cubonavicular plantar ligament - cubonavicular interosseus ligament Tarsometatarsal joints Tarsometatarsal joints Articular surfaces: - Cuneiform bones - cuboid bone Ligaments -Tarsometatarsal dorsal ligaments - tarsometatarsal plantar ligaments - tarsometatarsal interosseus ligaments Plain joints Sliding movements Metatarsophalangeal joints I Metatarsophalangeal joint Hinge joint - Flexion and extension Ligaments Collateral ligaments Metatarsophalangeal joints II – V metatarsophalangeal joints Ball and socket joints -Abduction and adduction - flexion and extension - circumduction Ligaments: Collateral ligaments Deep transverse metatarsal ligament Fractures of toes  Clubfoot Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which your baby's foot is twisted out of shape or position. In clubfoot, the tissues connecting the muscles to the bone (tendons) are shorter than usual. The term "clubfoot" refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club. Clubfoot is a fairly common birth defect and is usually an isolated problem for an otherwise healthy newborn. Bone cancer Myeloma  Pelvic diameters Bony pelvis: - 2 hip bones Guzowatość Ootwór górny - Sacral bone biodrowa miednicy Kolec biodrowy tylny Staw krzyżowo- górny Talerz biodrowy biodrowy Kresa graniczna Warga wewnętrzna Lesser pelvis (true pelvis) start zewnętrzna Guzek from linea terminalis. biodrowy Kresa graniczna Kość biodrowa Kość Kolec biodrowy przedni dolny Wyniosłość biodrowo- Linea terminalis is composed of kulszowa Kość łonowa łonowa Guzek łonowy - promontory Spojenie łonowe - arcuate line (2) - pecten pubis Grant’s Atlas of Anatomy 2009 - pubic symphysis 133 Opracowanie: dr n. med. Renata Wilk  Pelvic planes Pelvic inlet boundaries: Guzowatość Ootwór górny miednicy biodrowa Kość krzyżowa Wzgórek Kolec biodrowy tylny górny Linea terminalis Staw krzyżowo-biodrowy Talerz biodrowy Kresa graniczna Warga wewnętrzna Warga pośrednia Warga zewnętrzna Guzek biodrowy Kresa graniczna Kolec biodrowy Kość biodrowa przedni górny Kolec biodrowy przedni dolny Kolec kulszowy Kość kulszowa Wyniosłość biodrowo-łonowa Staw krzyżowo-guziczny Grzebień kości łonowej Kość łonowa Gałąź górna kości łonowej Otwór dolny miednicy Guzek łonowy Spojenie łonowe Grant’s Atlas of Anatomy 2009 134 Opracowanie: dr n. med. Renata Wilk  Pelvic planes Amplitudo pelvis Guzowatość biodrowa Wzgórek Otwór górny miednicy pelvic plane with the Kość krzyżowa Kolec biodrowy tylny górny Staw krzyżowo-biodrowy Talerz biodrowy largest dimensions Kresa graniczna Warga wewnętrzna boundaries: Warga pośrednia Warga zewnętrzna Middle part of pubic Guzek biodrowy Kresa graniczna symphysis, Kość biodrowa Kolec biodrowy przedni górny Central point of Kolec biodrowy przedni dolny Kość kulszowa Kolec kulszowy Wyniosłość biodrowo-łonowa acetabulum, Staw krzyżowo-guziczny Grzebień kości łonowej Kość łonowa Otwór dolny miednicy Gałąź górna kości łonowej Guzek łonowy Intervertebral disc Spojenie łonowe between S2 – S3 vertebra Grant’s Atlas of Anatomy 2009 135 Opracowanie: dr n. med. Renata Wilk  Pelvic planes Angustia pelvis the Guzowatość biodrowa Wzgórek Otwór górny miednicy pelvic plane with the Kość krzyżowa Kolec biodrowy tylny górny Staw krzyżowo-biodrowy Talerz biodrowy smallest dimensions Kresa graniczna Warga wewnętrzna Boundaries: Warga pośrednia Warga zewnętrzna Inferior margin of Guzek biodrowy Kresa graniczna the pubic symphysis Kość biodrowa Kolec biodrowy przedni górny Kolec biodrowy przedni dolny Ischial spine, Kolec kulszowy Kość kulszowa Staw krzyżowo-guziczny Wyniosłość biodrowo-łonowa Grzebień kości łonowej Apex of the sacra Kość łonowa Otwór dolny miednicy Gałąź górna kości łonowej Guzek łonowy bone. Spojenie łonowe Grant’s Atlas of Anatomy 2009 136 Opracowanie: dr n. med. Renata Wilk  Pelvic planes Guzowatość Otwór górny miednicy Pelvic outlet consist of Wzgórek biodrowa Kość krzyżowa Kolec biodrowy tylny górny 2 planes Staw krzyżowo-biodrowy Talerz biodrowy Kresa graniczna Warga wewnętrzna Boundaries: Warga pośrednia Warga Inferior margin of zewnętrzna Guzek biodrowy the pubic symphysis Ischial tuberosity Kresa graniczna Kolec biodrowy Kość biodrowa przedni górny Kość kulszowa Kolec biodrowy przedni dolny Kolec kulszowy Apex of the coccyx Wyniosłość biodrowo-łonowa Staw krzyżowo-guziczny Grzebień kości łonowej Kość łonowa Gałąź górna kości łonowej Otwór dolny miednicy Guzek łonowy Spojenie łonowe Grant’s Atlas of Anatomy 2009 137 Opracowanie: dr n. med. Renata Wilk  Internal pelvic diameters Anatomical conjugate – the distance between the promontory and the upper margin of pubic symphysis, 11,5 cm. True conjugate – the distance between promontory and retropubic eminence (0,5 cm lower than promontory) 11 cm Diagonal conjugate - distance between the promotory and the inferior margin of pubic symphysis, 12,5 - 13 cm Grant’s Atlas of Anatomy 2009 138 Opracowanie: dr n. med. Renata Wilk  Internal pelvic diameters Straight diameter of the amplitudo pelvis – distance between middle part of pubic symphysis and intervertebral disc between S2 – S3 vertebra 12,0 - 12,5 cm. Straight diameter of the angustia pelvis - distance between the lowest part of pubic symphysis and the apex of sacral bone, 11 cm. Straight diameter of the pelvic outlet distance between the lowest part of Grant’s Atlas of Anatomy 2009 pubic symphysis and the apex of coccyx, 9,5 cm.. 139 Opracowanie: dr n. med. Renata Wilk  Internal pelvic diameters Pelvis axis Connects central points of all straight diameters of the pelvic planes. Grant’s Atlas of Anatomy 2009 140 Opracowanie: dr n. med. Renata Wilk  Internal pelvic diameters Transverse diameter of the amplitudo pelvis– Interacetabular diameter distance between the central points of acetabulum of both sides, 12 cm. Transverse diameter of the angustia pelvis – (ischial interspinous diameter) – distance between both ischial spines,10,5 cm. Grant’s Atlas of Anatomy 2009 141 Opracowanie: dr n. med. Renata Wilk  Internal pelvic diameters Transverse diameter of the pelvic outlet – (ischial intertuberous distance – distance between both ischial tuberosities, 11 – 12 cm. Transverse diameter of the pelvic inlet – distance between terminal line of both sides, 13 cm. Grant’s Atlas of Anatomy 2009 142 Opracowanie: dr n. med. Renata Wilk  Internal pelvic diameters Oblique diameter of the pelvic inlet – distance between sacroiliac joint on one side to the iliopubic eminence on the other side, 12,5 cm. Grant’s Atlas of Anatomy 2009 143 Opracowanie: dr n. med. Renata Wilk  External pelvic diameters Intercristal distance – the distance between both iliac crests 28 – 29 cm. Interspinous distance – the distance between both anterior superior iliac spines 25 – 26 cm. Grant’s Atlas of Anatomy 2009 144 Opracowanie: dr n. med. Renata Wilk  External pelvic diameters Intertrochanteric distance – the distance between both greater trochanters 31 – 32 cm. External conjugate – the distance between upper margin of pubic symphysis and the spinous process of correct ≥ 20 cm. (19 cm – little shorter < 19 cm – shorter). Grant’s Atlas of Anatomy 2009 145 Opracowanie: dr n. med. Renata Wilk  External pelvic diameters Oblique external diameter: - right – distance between the right posterior superior iliac spine and left anterior superior iliac spine. Correct it is 22 cm. - left – distance between the left posterior superior iliac spine and right anterior superior iliac spine. Correct it is 21,5 cm. Grant’s Atlas of Anatomy 2009 146 Opracowanie: dr n. med. Renata Wilk