Transcript 1ab Mt SAC Lower Extremity

Os Coxa:
The fusion of 3 bones during childhood
Ilium
ischium
pubis
OS COXA
Acetabulum
Obturator
foramen
Lateral and Medial Views of the Hip
Bone
Tubercle of
the iliac crest
Anterior gluteal
line
Ilium
Iliac crest
Iliac crest
Anterior
superior
iliac spine
Anterior
superior
iliac spine
Ala
Iliac fossa
Posterior
gluteal line
Posterior
superior
iIiac spine
Posterior inferior
iliac spine
Greater sciatic
notch
Ischial body
Ilium
Inferior
gluteal line
Anterior inferior Anterior inferior
iliac spine
iliac spine
Arcuate
Acetabulum
line
Superior ramus
of pubis
Ischial spine
Pubic tubercle
Lesser sciatic
notch
Ischium
Ilium
Ischium
Pubis
Pubic body
Pubis
Ischial
tuberosity
Ischial ramus
(b) Lateral view, right hip bone
Inferior ramus
of pubis
Articular surface of
pubis (at pubic
symphysis)
Inferior ramus
of pubis
Posterior
superior
iliac spine
Posterior
inferior
iliac spine
Body of
the ilium
Auricular
surface
Ischial spine
Obturator
foramen
Ischium
Ischial ramus
(c) Medial view, right hip bone
Figure 8.8b, c
ILIUM
Iliac crest
Anterior superior
iliac spine
Iliac fossa
Posterior superior
iliac spine
Posterior inferior
iliac spine
Anterior inferior
iliac spine
Greater sciatic notch
ILIUM
Auricular surface
and sacroiliac
joint
Greater sciatic notch
Arcuate
line
Ischial spine
Lesser sciatic notch
ISCHIUM
Anterior
Ischial spine
Lesser sciatic
notch
Ischial tuberosity
ISCHIUM
Posterior
Ischial spine
Lesser sciatic notch
Pubic bone
Ischial tuberosity
PUBIS
Superior
ramus
Pubic bone
Inferior ramus
PUBIS
Pubic symphysis
Symphyseal surface
Pubic arch
Female
pelvis
Male
pelvis
Female
pelvis
Pelvic brim
Pubic arch
is broader
in female
Pubic arch
is narrower
in male
Male
pelvis
Male
pelvis
Female
pelvis
How to tell and right and left os
coxa
• Place the auricular surface against the
clothing on your hip, with the pubis facing
anteriorly. The acetabulum should point
laterally.
FEMUR
Greater trochanter
Neck
Lesser trochanter
Head
FEMUR
Head
Neck
Greater trochanter
Intertrochanteric
crest
Lesser trochanter
Intertrochanteric crest
(posterior)
Intertrochanteric line
(anterior)
FEMUR
Medial condyle
Gluteal tuberosity
Linea aspera
Popliteal fossa
Intercondylar
notch
Lateral condyle
FEMUR
Medial epicondyle
(adductor tubercle)
Medial condyle
Lateral condyle
How to tell right from left femur?
• Place the femur on the anterior surface of
your thigh, with the linea aspera touching
your pants. The head of the femur should
face medially towards the body.
Medial condyle
Lateral condyle
Tibial tuberosity
TIBIA
Medial malleolus
Fibular notch
TIBIA
Medial malleolus
TIBIA
Medial malleolus
Fibular notch
TIBIA
Medial malleolus
Fibular notch
TIBIA
Medial condyle
Lateral condyle
Tibial tuberosity
TIBIA
Intercondylar eminance
How to tell right and left tibia?
• Place the tibia on the anterior surface of
your leg with the tibial tuberosity facing
anteriorly (not touching your leg). What
side is the medial malleolus on? It should
be medial, towards the midline of the
body.
FIBULA
Lateral
malleolus
Lateral
malleolus
Head
Head
How to tell R from L fibula
• Place the fibula on the table with the smooth
side of the lateral malleolus facing down.
Pretend to trace the malleolus. Notice that one
side (posterior) is straight and the other side
(anterior) is curved.
• Place the smooth surface of the lateral
malleolus against your sock at your own
lateral malleolus. The curved edge should
face anteriorly, not posteriorly.
TARSALS
NAVICULAR
MEDIAL (or 1st)
CUNEIFORM
TALUS
INTERMEDIATE (or 2nd)
CUNEIFORM
CUBOID
CALCANEUS
LATERAL (or 3rd)
CUNEIFORM
Medial facet of talus
Lateral facet of talus
Calcaneal
tuberosity
CALCANEUS
The facets are the smooth
surface on the sides of the talus
Lateral facet
of talus
Medial facet
of talus
Lateral facet
of talus
METATARSALS: 1-5
FIRST METATARSAL
Styloid Process
FIFTH METATARSAL
PHALANGES
PROXIMAL PHALANX,
FIRST DIGIT
DISTAL PHALANX,
FIFTH DIGIT
DISTAL PHALANX,
FIRST DIGIT
INTERMEDIATE
PHALANX,
THIRD DIGIT
Patella (pat Ella, don’t PET Ella)
Medial articular
facet
(convex)
Base
Lateral
border
Medial
border
Apex
Lateral articular
facet
(concave)
Patella
Medial articular
facet
The Lateral facet is larger.
If you place the patella on
your desk, it will always fall
onto the lateral articular
facet.
Lateral articular
facet
Turning An Ankle Into A 'Knee'
• Patient was a five-year-old girl with Ewing's
sarcoma, a cancerous tumor, behind her left
knee. Surgeons at The Children's Hospital of
Philadelphia used a limb-sparing technique
called rotationplasty to remove the diseased
portion of bone, turn the shortened portion of the
leg bone in a half-circle and reattach it, with the
ankle joint functioning as a knee.
• With a prosthetic attached to the mobile joint, the
child, now 13, enjoys gymnastics and
cheerleading.
Turning An Ankle Into A 'Knee'
Video of the 13-year-old patient, walking with a normal gait, can be viewed here:
http://content.nejm.org/cgi/content/full/351/8/e7
Rotationplasty
• VIDEO
• MBA Implant