Lesson-56 (Bones of the Lower Limb).pdf

Bones of Lower Limb Parts of the lower limb Pelvic girdle Thigh Leg Foot THE SKELETON of the PELVIC GIRDLE HIP BONES (L: coxae) Symphysis pubis (pubic symphysis) FOOT Tarsal bones Metatarsal bones Phalanges HIP BONE [COXAE] joined by hyaline cartilage incompletely ossified 2/5 2/5 between 14 & 16 ye...

Bones of Lower Limb Parts of the lower limb Pelvic girdle Thigh Leg Foot THE SKELETON of the PELVIC GIRDLE HIP BONES (L: coxae) Symphysis pubis (pubic symphysis) FOOT Tarsal bones Metatarsal bones Phalanges HIP BONE [COXAE] joined by hyaline cartilage incompletely ossified 2/5 2/5 between 14 & 16 years of age 1/5 ILIUM WING (ALA) Iliac fossa BODY Posterior to the iliac fossa: Sacropelvic surface Sacropelvic junction iliac tuberosity Auricular surface ILIUM Iliac crest Ant sup iliac spine Ant inf iliac spine L3-L4/L4 Lumbar punction Anterior Superior Iliac Spine Sartorius M Inguinal lig Tensor fascia latae ILIUM Post sup iliac spine Post inf iliac spine Greater sciatic notch clinical importance of the posterior superior iliac spine S2 sacrotuberous lig bone marrow biopsy lateral (gluteal) surface of the ilium Ant gluteal line Inf gluteal line Post gluteal line ischium BODY ramus of ischium ischium ischial tuberosity ischial spine lesser sciatic notch Dekubitus Ülseri commons.wikimedia.org The structures passing through the greater sciatic foramen piriformis muscle sup gluteal n.a. v inf gluteal n.a.v sciatic n. posterior femoral cutan n. pudental n. internal pudental a.v. Lesser sciatic foramen gluteal region – perineum – pudental n. – internal pudental a.v – tendon of obturator internus pubis sup pubic ramus BODY Inf pubic ramus Anatomical relations of the superior ramus & inferior ramus pectineus muscle Adductor magnus muscle Pectineus muscle pubis pubic symphysis Symphysial surface Ischiopubic ramus pubis Arcuat line Pectineal line (Pecten pubis) Pubic tubercle Pubic crest PELVIC BRIM Lesser pelvis (true pelvic cavity) Greater pelvis (False pelvic cavity) ACETABULUM Lunate surface Acetabular fossa Acetabular notch OBTURATOR FORAMEN Obturator groove Obturator canal Avulsion fractures of the hip bone Avulsion fractures of the hip bone may occur during sports such as sprinting or kicking in football, jumping and basketball A small part of bone with a piece of tendon or ligament attached is «avulsed» (torn away) Avulsion fractures occur where muscles are attached: ASIS, AIIS, ischial tuberosities and ischiopubic rami Pelvic Fractures Anteroposterior compression of the pelvis occurs during crush accidents This type of trauma commonly produces fractures of the pubic rami When the pelvis is compressed laterally the acetabulum and ilium may be broken Pelvic fractures may cause injury to pelvic soft tissues, blood vessels, nerves and organs Falls on the feet or buttocks from a high ladder may drive the head of the femur through the acetabulum into pelvic cavity injuring the pelvic viscera, nerves and vessels In individuals younger than 17 years of age, the acetabulum may fracture through the Y shaped cartilage into its three developmental parts FEMUR FEMUR second bone that starts ossification FEMUR NECK HEAD Greater trochanter Lesser trochenter ANT POST Greater Trochan ter FEMUR HEAD Fovea for ligament of head Head of the FEMUR Fovea for ligament of head Coxa Vara & Coxa Valga The angle of inclination between the long axis of the femoral neck and the femoral shaft varies with age, sex and development of the femur When the angle of inclination is decreased, the condition is coxa vara; when it is increased, it is coxa valga FEMUR 126 BODY FEMUR Trochanteric fossa Greater trochanter Lesser trochanter POST Surface abductors & rotators of thigh The FEMUR intertrochanteric crest POST SURFACE FEMUR intertrochanteric line ANT SURFACE FEMUR ANT SURFACE POST SURFACE Pectineal line Medial lip Gluteal tuberosity Lateral lip Linea aspera Adductors of thigh FEMUR ANT SURFACE Medial Supracondylar line POST SURFACE lateral Supracondylar line Popliteal surface FEMUR Medial epicondyle Lat epicondyle Adductor tubercle Lat epicondyle Patellar surface Intercondylar fossa Fractures of the Femur Femoral fractures becomes increasingly vulnerable with age, especially in females, secondary to osteoporosis Fractures of proximal femur occur at several locations: two examples are transcervical (middle of neck) and intertrochanteric These fractures usually occur as a result of indirect trauma (stumbling or stepping down hard) Intracapsular fractures occuring within the hip joint capsule are complicated by degeneration of the femoral head because of the vascular trauma Fractures of the greater trochanter and femoral shaft usually result from direct trauma and they are most common during the more active years. They frequently occur motor accidents and sports such as climbing PATELLA Base of patella Articular surface apex ANT SURFACE POST SURFACE Head TIBIA Lateral condyle Medial condyle ANT SURFACE POST SURFACE TIBIA Lateral condyle Medial condyle ANT SURFACE POST SURFACE GERDY TUBERCLE Superior surface of the proximal end of the TİBİA intercondylar eminence Medial and lateral condylar tubercle Ant intercondylar area Post intercondylar area TIBIA Articular surface Tibial tuberosity Nutrient foramen ANT POST LAT TIBIA POST Lat condyle Soleal line Fibular notch Medial malleolus Art surface Fibula The fibula is a common source of greft material Even after a segment of the shaft has been removed, walking, running, and jumping can be normal The fibula has no function in carrying the body’s weight, it serves mainly for muscle attachment The proximal end of the fibula consists of an enlarged head superior to the small neck FIBULA POST APEX HEAD NECK interosseous border lateral malleolus Malleolar articular surface Fibular Fractures Fibular fractures commonly occur 2-6 cm proximal to the distal end of the lateral malleolus and are often associated with fracture-dislocations of the ankle joint, which are combined with tibial fractures Fractures of the lateral and medial malleoli are relatively common in soccer and basketball players Fibular fractures can be painful because of the disrupted muscle attachments Fracture of lateral malleolus Fractures of Lateral & Medial Malleoli Medial Malleol Lateral Malleol foot 7 tarsal bones [Talus, calcaneous, navicular, cuboid, three cuneiform] 5 metatarsal 14 phalanges FOOT Cuboid Navicular 1 2 3 Calcaneus PLANTAR SURFACE TALUS DORSAL SURFACE Heel of the foot Bones of the foot Talus: articulates with the leg bones -calcaneus-naviculare – the most superior bone – key bone of the arch of foot – muscles do not attach talus TALUS Sup surface of the Talus Trochlea tali inf surface Bones of the foot Calcaneus: largest of tarsal bones  heel bone  first bone in the foot that starts ossification  only short bone which ossified from the secondary ossification center  only tarsal bone which contacts the ground  art with the talus & cuboid CALCANEUS Sustentaculum tali shelf like projection from the superior border of the medial surface of the calcaneus. support the talus