Transcript The femoral canal

Dr. S. Nishan Silva
(MBBS)
Surface Anatomy:
Anterior Thigh + Leg
 Palpate
 Patella
 Condyles of femur
 Femoral Triangle
 Sartorius (lateral)
 Adductor longus (medial)
 Inguinal ligament
(superior)
 Femoral a + v, lymph nodes
pg 785
Frolich, Human Anatomy, Lower LImb
Surface Anatomy of the Lower Limb
 Surface features of the Thigh
 Sartorius muscle
 Quadriceps femoris muscle
 Adductor longus muscle
 Hamstring muscles
 Femoral triange
12-3
Superficial structures
Great saphenous vein
 Drains the medial end of dorsal venous arch of
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foot
Passes upward directly in front of the medial
malleolus.
Then ascends on medial side of the leg.
Passes behind the knee and curves forward
around the medial side of the thigh.
Passes through the saphenous hiatus in the
deep fascia and joins the femoral vein about 4
cm below and lateral to the pubic tubercle.
Superficial structures
 Tributaries:
 Superficial lateral femoral v.
 Superficial medial femoral v.
 External pudendal v.
 Superficial epigastric v.
 Superficial iliac circumflex v.
Varicose veins
Superficial structures
Superficial fascia
 Superficial arteries:
 superficial epigastric a.
 superficial iliac circumflex a.
 external pudendal a.
 Cutaneous nerves:
 lateral femoral cutaneous n.
 anterior and medial cutaneous branches of
femoral n.
 cutaneous branches of obturator n.
lateral femoral cutaneous n.
anterior and medial
cutaneous branches of
femoral n.
Cutaneous branches of
obturator n.
Superficial structures
Superficial inguinal lymph nodes
 Superior group:
 Lies just distal to the inguinal ligament
 Receive lymph vessels from anterior
abdominal wall below umbilicus, gluteal
region, perineal region, external genital
organs
 Inferior group:
 Lies vertical along the terminal great
saphenous v.
 Receives all superficial lymph vessels of lower
limb, except for those from the posterolateral
part of calf
 Efferent vessels drain into the deep inguinal
ln. or external iliac ln.
Deep fascia of the thigh
 Fascia lata
The deep fascia encloses the thigh like a trouser leg.
 Saphenous hiatus
 A gap in the deep fasica which lies about 4 cm
below and lateral to the pubic tubercle. The
falciform margin is the lower lateral border of
the opening, which lies anterior to the femoral
vessels.
 Filled with loose connective tissue called the
cribriform fascia
Deep fascia of the thigh
 Iliotibial tract
laterally the deep fascia forms a thick
band, from the iliac tubercle to the
lateral condyle of tibial.
 The fascia lata sends intermuscular
septa to the linea aspera of the femur.
These separate the thigh into three
compartments each of which contains a
group of muscles, the vessels and the
nerves.
Lacuna musculorum
 Boundaries:
Lateral femoral cutaneous n.
Iliopsoas
Iliopectinal arch
Femoral n.
 Anteriorly: lateral portion of
inguinal ligament
 Posterolaterally: ilium
 Medially: iliopectinal arch
 Contents:
 Iliopsoas
 femoral n.
 lateral femoral cutaneous n.
Lacuna vasorum
 Boundaries:
 Anteriorly: medial portion of
inguinal ligament
 Posteriorly: fascia of pecteineus
and pectineal ligament
 Medially: lacunar ligament
 Laterally: iliopectinal arch
 Contents:
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Femoral sheath
Femoral a. and v.
Genital branch of genitofemoral n.
Lymphatic vessels
Femoral a.
Femoral v.
Femoral ring
Anterior/Posterior compartments
ANTERIOR
POSTERIOR
COMPARTMENT COMPARTMENT
MOVEMENT
Extension
Flexion
MUSCLES
Quads
Shin
Hamstrings
Gastrocs
NERVES
Femoral n.
(lumbar plexus)
Sciatic n.
(sacral plexus)
Frolich, Human Anatomy, Lower LImb
BONY ANATOMY OF THE FEMUR
BONY ANATOMY OF THE FEMUR
Thigh movements by compartment
Frolich, Human Anatomy,
Lower LImb
Anterior thigh (femoral n.)
 Sartorius (Tailor’s
muscle)
 Quads (four)
 Rectus femoris
(crosses hip)
 3 vastus mm. (vast-big)
Frolich, Human Anatomy, Lower LImb
Musculature
 Anterior
 Rectus Femoris
 Vastus Lateralis
 Vastus Intermedius
 Vastus Medialis
Musculature
 Anterior
 Posterior
 Semimembranosus
 Semitendinosus
 Biceps femoris
 Popliteus
Musculature
 Lateral restrainers of
knee
 Tensor Fascia Lata
 Iliotibial Band
Posterior Thigh
Frolich, Human Anatomy, Lower LImb
 Gluts (gluteal nn.)
 Maximus—extensor of thigh
 Medius--pelvic tilt
 Lateral rotators (spinal nn.)
 Piriformis syndrome
 Hamstrings (sciatic n.)
 Biceps femoris
 Semimembranous
 Semitendinous
Medial compartment (obturator n.)
Frolich, Human Anatomy, Lower LImb
 Adductor muscles
 Gracilis
 Adductor
 Magnus
 Longus
 brevis
Femoral triangle
A triangular depressed area situated in the upper
part of the medial aspect of the thigh just below
the inguinal ligament
Boundaries
 Superiorly (base) : the inguinal ligament
 Laterally: medial border of sartorius
 Medially: medial border of adductor longus
 Apex: continuous with adductor canal
 Anterior wall: fascia lata
 Posterior wall: consists of iliopsoas, pectineus
and adductor longus from lateral to medial side
Femoral triangle
Contents
 Femoral n.
 Femoral sheath
 Femoral a. and its branches
 Femoral vein and its tributaries.
 Femoral canal
 Deep inguinal lymph nodes
 Fatty tissue
Femoral triangle
Femoral sheath
 A funnel- shaped sheath
 Derived from transversalis fascia
anteriorly and iliac fascia posteriorly
 It surroumds the femoral vessels and
lymphatic about 2.5cm belower the
inguinal ligamemt.
 Its lower end disappears at the lower
margin of the saphenous opening
where the sheath fuses with the
adventitia of the vessels.
Femoral sheath
Femoral sheath
Divided into three compartments by two fibrous septa
 Lateral compartment: femoral a.
 Middle compartment: femoral v.
 Medial compartment: femoral canal
The femoral canal
 About 1.3cm long , and its upper opening
is called the femoral ring
 Contains: a little loose fatty tissue, a small
lymph node, and some lymph vessels.
 The boundaries of the femoral ring
 Anteriorly: the inguinal ligament
 Medially: the lacunar ligament
 Posteriorly: the pecten of pubis
 Laterally: the femoral vein
 Superior: covered by femoral septum
Femoral hernia
 If a loop of intestine is forced into the
femoral ring, it expands to form a
swelling in the upper part of the thigh.
Such a condition is known as a femoral
hernia .
 A femoral hernia is more common in
women than in men (possibly because
their wider pelvis and femoral canal ).
Femoral artery
Femoral a.
 Continuation of the external iliac a.
 Begins midpoint of inguinal ligament
 Ends at the adductor tendinous opening by
entering the popliteal fossa as the popliteal
artery
 Principal branch－deep femeral a.
arises from the posterolateral surface of the femoral artery
about 5 cm below the inguinal ligament.
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Medial femoral circumflex
lateral femoral circumflex
Four perforating arteries
Profunda femoris
 Arises from the posterolateral surface of
the femoral artery about 5 cm below the
inguinal ligament.
 Branches:
 Lateral circumflex artery.
 Medial circumflex artery.
 Perforating arteries
deep femeral a.
Lateral circumflex a.
perforating arteries
Medial circumflex a.
Femoral vein
 Begins at the adductor tendinous
opening
 Continues as external iliac vein deep to
inguinal ligament
 Contains several valves
The deep inguinal lymph nodes
 Lie medial to the femoral v.
 Receive deep lymphatics of lower
limb, perineal region, and efferent
lymphatics from the superficial
inguinal ln.
 Drain into the external iliac ln.
Femoral nerve
 Arises from the lumbar plexus in the
abdomen, and enters the thigh posterior
to the inguinal ligament and lateral to the
femoral artery.
 It ends by dividing into a number of
branches 2 cm below the inguinal
ligament.
 Muscular branche to: pectineus, sartorius,
quadriceps femoris
Femoral nerve
 Cutaneous branches:
 Anterior cutaneous nerves of
the thigh
 Saphenous nerve is the
longest branch of the femoral
nerve. It accompanies the
femoral vessels in the adductor
canal, then accompanies the
great saphenous vein to the
medial side of the leg and food.
Femoral n.
Femoral a.
Femoral v.
Saphenous nerve
Adductor canal
 An intermuscular cleft situated on the medial aspect
of the middle third of the thigh beneath the sartorius.
 Extends from apex of femoral triangle to adductor
tendinous opening
 Boundies
 Anterior wall: adductor lamina and sartorius
 Lateral wall : vastus medialis
 Posteomedial wall: adductors longus and magmus
 Contents
 Saphenous n.
 Femoral a. and femoral v.
 lymphatic vessels and loose connective tissue
Blood vessels and nerve of medial side of thigh
 Obturator a.
 Arises from internal iliac artery in the
lesser pelvis
 passes through the obturator canal where
it divides into anterior and posterior
branches.
 Obturator n.
 Arises from the lumbar plexus in the
abdomen.
 Enters the thigh through the obturator
canal where it divides into anterior and
posterior branches.
 Supplies medial group of muscles of
thigh, obturator externus, and skin of
medial side of thigh
Obturator n.
Strains-hamstring
Strains- groin
FRACTURED LT. FEMUR
AP
LAT