Transcript The Skeleton of the lower Limb

The Skeleton of the
lower Limb
by
Oday Abdulqader
Latin Names and English Equivalents
for Parts of the Limb Lower
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Coxa
Natis or clunis
Femur
Genu
Crus
Sura
Talus
Pes
Calx
Planta
Digiti pedis
Hallux
English
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Hip
Buttock
Thigh
Knee
Leg
Calf
Ankle
Foot
Heel
Sole
Toes
Big toe
Lower Limb
• The lower limb
(extremity) is
specialized for (1)
locomotion (the ability
to move from one
place to another), (2)
bearing weight, and (3)
maintaining balance.
Hip
• The hip , containing the hip
bone (os coxae, innominate
bone), which connects the
skeleton of the lower limb to
the vertebral column.
• The hip bones articulate
posteriorly with the sacrum
and meet anteriorly at the
pubic symphysis.
Hip
• The pelvic girdle (which is formed by the two hip
bones), together with the sacrum and coccyx, form
the skeleton of the bony pelvis.
Thigh
• The thigh, containing
the femur (thigh bone)
and connecting the hip
joint and knee joint.
Leg
• The leg , containing the
tibia (medial leg bone,
“shin bone“) and fibula
(lateral leg bone, “splint
bone“), which connect
the knee joint and ankle
joint.
Foot
• The foot containing the
tarsus (bones posterior
and middle parts of the
foot), metatarsus
(bones anterior part of
the foot), and
phalanges (bones of
digits or toes).
Hip Bone
• The hip bone (L. os
coxae) is the large,
irregularly shaped bone.
• It is formed by three
bones: ilium, ischium,
and pubis.
• Before puberty, these
bones are separated by
cartilage.
Hip Bone
• They begin to fuse at
the acetebulum at 15 to
17 years of age to form
one hip bone.
• Fusion is usually
complete by age 23
years.
• Hence these bones are
indistinguishably joined
in the adult.
Hip Bone
• The hip bone has a cupshaped socket, the
acetebulum, on its
lateral aspect for
articulation with the
head of the femur.
• It was given its name
because of its
resemblance to a
shallow Roman vinegar
cup (L. acetebulum).
Hip Bone
• The medial aspect of
the hip bone is
concerned with pelvic
and perineal structures
and functions.
• The lateral aspect of the
hip bone is concerned
with lower limb
structures and
functions.
Ilium
• This bone is fanshaped;
its ala (L. wing)
resembles the spread of
a fan and its body
represents the handle.
• The iliac fossa is a
concavity in the ala of
the ilium and forms part
of the posterior
abdominal wall.
Ilium
• The body of the ilium
joins the pubis and
ischium, and takes part
of the formation of the
acetabulum.
• The ilium forms the
superior two-third of
the hip bone and the
superior two-fifths of
the acetabulum.
Ilium
• The iliac crest has
internal and external
lips and its posterior
part is thicker than
other parts.
• The iliac crest ends
anteriorly in a rounded
anterior superior iliac
spine (ASIS), which is
easily felt and may be
visible.
Ilium
• The iliac crest ends
posteriorly in a sharp
posterior superior iliac
spine (PSIS), which is
difficult to palpate in
most people.
• Another palpable bony
landmark, the tubercle
of the iliac crest (iliac
tubercle), is located on
the external lip about 5
cm posterior to the
ASIS.
Ilium
• The anterior inferior
iliac spines and
posterior inferior iliac
spines are often difficult
to identify by palpation.
• The posterior inferior
iliac spine marks the
superior end of the
greater sciatic notch.
Ilium
• The lateral surface of
the ala of the ilium has
three rough curved
lines—the posterior,
anterior, and inferior
gluteal lines—that
demarcate the proximal
attachments of the
three large gluteal
muscles (pl., glutei).
Ilium
• Posteriorly, the medial
aspect of the ilium has a
rough, ear-shaped
articular area called the
auricular surface (L.
auricula, a little ear).
• There is also a rougher
iliac tuberosity superior
to the auricular surface.
Ischium
• The ischium forms
posteroinferior third of
the hip bone and the
posterior two-fifths of
the acetabulum.
• The ischium (G. hip) is
the roughly L-shaped part
of the hip bone.
• It passes inferiorly from
the acetebulum and then
turns anteriorly to join
the pubis.
Ischium
• The ischium consists of
two parts, a body and a
ramus.
• The body of the
ischium, its superior
thick portion, is fused
with the ilium and the
pubis at the
acetabulum.
Ischium
• The ramus of the
ischium joins the
inferior ramus of the
pubis to form a bar of
bone, the ischiopubic
ramus.
• The ischial spine
projects from the
posterior border of the
ischium and intervenes
between the greater
and lesser sciatic
notches.
Ischium
• The rough bony
projection at the
junction of the inferior
end of the body of the
ischium and its ramus is
the large ischial
tuberosity.
• The body’s weight rests
on this tuberosity when
sitting.
Pubis
• The pubis forms the
inferomedial part of the
hip bone and the
anteromedial one-fifth
of the acetabulum.
• The pubis consists of
three parts: a body and
two rami.
• Its flattened body lies
medially.
Pubis
• The superior ramus of
the pubis passes
superolaterally to the
acetabulum, where it is
fused with the ilium and
ischium.
• The inferior ramus of
the pubis passes
posteriorly, inferiorly,
and laterally to join the
ramus of the ischium
and form the
ischiopubic ramus.
Pubis
• The body of the pubis
joins the body of the
opposite pubis in the
median plane, called
the pubic symphysis.
• The superior border of
the body of the pubis is
thickened to form the
pubic crest.
Pubis
• At its lateral end there
is an anterior-projecting
prominence, known as
the pubic tubercle.
• The pubic tubercle,
which can be palpated
about 2.5 cm from the
median plane.
Pubis
• From the pubic tubercle
two ridges diverge
laterally into the
superior ramus.
• The superior ridge,
called the pecten pubis
(pectineal line) is sharp
and forms part of the
pelvic brim.
• The inferior ridge, called
the obturator crest is
more rounded.
Obturator Foramen
• The obturator foramen is a large oval or irregularly
triangular opening in the hip bone.
• It is bounded by the bodies and rami of the pubis
and ischium.
Obturator Foramen
Obturator membrane
• Except for a small passageway for the obturator
nerve and vessels (the obturator canal), the
obturator foramen is closed by the thin, strong
obturator membrane.
Acetebulum
• The acetabulum is the large cup-shaped cavity on
the lateral aspect of the hip bone that articulates
with the head of the femur to form the hip joint.
Acetebulum
• The margin of the
acetabulum is
incomplete inferiorly at
the acetabular notch.
• The rough depression in
the floor of the
acetabulum extending
superiorly from the
acetabular notch is the
acetabular fossa.
Acetebulum
• The smooth lunate
surface of the
acetabulum is the
articular surface
receiving the head of
the femur.
Femur
• The femur (thigh bone)
is the longest, strongest,
and heaviest bone in the
body.
• A person’s height is
roughly four times the
lenght of his/her femur.
• It extends from the hip
joint to the knee joint.
Femur
• The femur consists of a body
(shaft) and two ends
(extremities).
• The proximal end of the
femur has a head, a neck,
and greater and lesser
trochanters.
• The distal end is broadened
by medial and lateral
condyles where it articulates
with the tibia and patella to
form the knee joint.
Femur
• The head of the femur
is smooth and forms
about two-thirds of a
sphere and articulates
with the acetabulum of
the hip bone to form
the hip joint.
Femur
• In the center of the head is a small depression, called
the fovea capitis, for the attachment of the ligament
of the head.
Femur
• The neck of the femur
connects the head to
the body.
• The body runs
inferolaterally making
an angle of 125 degrees
with the neck of the
femur.
Femur
• The neck is limited
laterally by the greater
trochanter.
• The intertrochanteric
line runs inferomedially
from the greater
trochanter.
Femur
• The intertrochanteric
line passes inferior to
the lesser trochanter
and becomes
continuous with the
spiral line (pectineal
line) on the posterior
aspect of the femur.
• The intertrochanteric
line is formed by the
attachment of the
massive iliofemoral
ligament.
Femur
• A prominent ridge, the
intertrochanteric crest,
unites the two trochanters
posteriorly.
• The greater trochanter of
the femur is a large,
somewhat rectangular
projection from the junction
of the neck and body.
• It provides an attachment for
several muscles of the
gluteal region.
Femur
• The greater trochanter
lies laterally, close to
skin, and can be easily
palpated on the lateral
side of the thigh.
• Because it is the most
lateral point of the hip
region, the greater
trochanter causes you
discomfort when you lie
on your side on a hard
surface.
Femur
• The medial surface of
the greater
trochanter has a deep
depression, called
the trochanteric fossa.
Femur
• The lesser trochanter of
the femur projects from
the posteromedial
surface of the femur at
the inferior end of the
intertrochanteric crest.
• It is located in the angle
between the neck and
body of the femur.
Femur
• The shaft of the femur
is slightly bowed
(convex) anteriorly.
• Inferior to the neck, the
body is smooth except
the rough ridge of bone,
called linea aspera (L.
rough line), in the
middle of its posterior
surface.
Femur
• The linea aspera has
medial and lateral lips,
which diverge inferiorly
to form medial and
lateral supracondylar
lines.
Femur
• The pectineal line runs
from the lesser
trochanter to the
medial lip of the linea
aspera.
• The tendon of the
pectineus muscle is
attached to it.
Femur
• The distal end
(extremity) of the femur
is broadened for
articulation with the
tibia.
• Two large condyles (G.
knuckles) project
posteriorly and are
separated by a deep Ushaped intercondylar
notch.
Femur
• The patellar surface is
where the patella
(kneecap) slides during
flexion and extension of
the leg at the knee
joint.
• The lateral and medial margins of the patellar
surface can be palpated when the leg is flexed.
Femur
• Superior the condyles are the medial and lateral
epicondyles.
• The adductor tubercle is continuous with the medial
epicondyle.
Femoral Neck Fractures
• Fractures of the neck of
the femur usually
results from indirect
violence and often
results from tripping
over something (e.g., a
rug).
Femoral Neck Fractures
• These fractures are
more common in older
women than in men
because their bones
markedly weakened
owing to
postmenopausal
osteoporosis.
• In this condition, bone
resorption is greater
than bone formation.
Femoral Neck Fractures
• When one hears that an
old person has
a‟broken hip”, the usual
injury is a fracture of
the femoral neck.
Patella
• The patella is the largest
sesamoid bone (i.e., a
bone that develops
within the tendon of
the quadriceps femoris
muscle in front of the
knee joint).
Patella
• It is triangular, and its
apex lies inferiorly; the
apex is connected to
the tuberosity of the
tibia by the patellar
ligament (ligamentum
patellae).
Patella
• The posterior surface
articulates with the
condyles of the femur.
• The patella is situated in
an exposed position in
front of the knee joint.
• It is subcutaneous and
can be easily palpated.
Patella
• The patella is thought
to increase the power
of the already strong
quadriceps femoris
muscle by increasing its
leverage.
Tibia
• The tibia is the large
weight-bearing medial
bone of the leg.
• It articulates with the
condyles of the femur
and the head of the
fibula above and with
the talus and the distal
end of the fibula below.
• It has an expanded
upper end, a smaller
lower end, and a shaft.
Tibia
• At the upper end are
the lateral and medial
condyles (sometimes
called lateral and
medial tibial plateaus),
which articulate with
the lateral and medial
condyles of the femur.
Tibia
• Separating the upper
articular surfaces of the
tibial condyles are
anterior and posterior
intercondylar areas;
lying between these
areas is the
intercondylar
eminence.
Tibia
• The lateral condyle
possesses on its lateral
aspect a small circular
articular facet for the
head of the fibula.
Tibia
• The shaft of the tibia is
triangular in cross
section, presenting
three borders and three
surfaces.
• Its anterior and medial
borders, with the
medial surface between
them, are
subcutaneous.
Tibia
• At the junction of the
anterior border with the
upper end of the tibia is
the tibial tuberosity,
which receives the
attachment of the patellar
ligament.
• The anterior border
becomes rounded below,
where it becomes
continuous with the
medial malleolus.
Tibia
• The lateral or
interosseous border
gives attachment to the
interosseous
membrane.
Tibia
• The posterior surface of
the shaft shows an
oblique line, the soleal
line, for the attachment
of the soleus muscle.
• The lower end of the
tibia is slightly
expanded and on its
inferior aspect shows a
saddle-shaped articular
surface for the talus.
Tibia
• The lower end is prolonged downward medially to
form the medial malleolus.
• The lateral surface of the medial malleolus articulates
with the talus.
Tibia
• The lower end of the tibia shows a wide, rough
depression (fibular notch) on its lateral surface for
articulation with the fibula.
Fibula
• The fibula is the slender
lateral bone of the leg.
• It takes no part in the
articulation at the knee
joint, but below it forms
the lateral malleolus of
the ankle joint.
• It takes no part in the
transmission of body
weight, but it provides
attachment for muscles.
Fibula
• The fibula has an
expanded upper end, a
shaft, and a lower end.
• Upper end consist of head.
• Cuboidal projection is
observed on the head
called the apex.
• It possesses an articular
surface for articulation
with the lateral condyle of
the tibia.
Fibula
• The shaft of the fibula
is long and slender.
• The lower end of the
fibula forms the
triangular lateral
malleolus, which is
subcutaneous.
Fibula
• Typically, it has four
borders and four
surfaces.
• The medial or
interosseous border
gives attachment to the
interosseous
membrane.
Fibula
• On the medial surface
of the lateral malleolus
is a triangular articular
facet for articulation
with the lateral aspect
of the talus.
• Below and behind the
articular facet is a
depression called the
malleolar fossa.
Tarsal Bones
• The tarsal bones are the
calcaneus, the talus, the
navicular, the cuboid,
and the three
cuneiform bones.
Tarsal Bones
• Only the talus
articulates with the
tibia and the fibula at
the ankle joint.
Calcaneus
• The calcaneus is the
largest bone of the foot
and forms the
prominence of the heel.
• It articulates above with
the talus and in front
with the cuboid.
Calcaneus
• It has six surfaces.
• The anterior surface is
small and forms the
articular facet that
articulates with the
cuboid bone.
• The posterior surface
forms the prominence
of the heel and gives
attachment to the
tendo calcaneus
(Achilles tendon).
Calcaneus
• The superior surface is
dominated by two
articular facets for the
talus, separated by a
roughened groove, the
sulcus calcanei.
Calcaneus
• The inferior surface has
an anterior tubercle in
the midline and a large
medial and a smaller
lateral tubercle at the
junction of the inferior
and posterior surfaces.
Calcaneus
• The medial surface
possesses a large,
shelflike process,
termed the
sustentaculum tali,
which assists in the
support of the talus.
Calcaneus
• The lateral surface is
almost flat.
• On its anterior part is a
small elevation called
the peroneal tubercle,
which separates the
tendons of the
peroneus longus and
brevis muscles.
Talus
• The talus articulates above at the ankle joint with the
tibia and fibula, below with the calcaneus, and in
front with the navicular bone.
Talus
• It possesses a head, a
neck, and a body .
• The head of the talus is
directed distally and has
an oval convex articular
surface for articulation
with the navicular bone.
Talus
• The neck of the talus
lies posterior to the
head and is slightly
narrowed.
Talus
• Its lower surface shows
a deep groove, the
sulcus tali.
Talus
• The sulcus tali and the sulcus calcanei in the
articulated foot form a tunnel, the sinus tarsi, which is
occupied by the strong interosseous talocalcaneal
ligament.
Talus
• The body of the talus is
cuboidal.
• Its superior surface
articulates with the
distal end of the tibia.
Talus
• Its lateral surface
presents a triangular
articular facet for
articulation with the
lateral malleolus of the
fibula.
• Its medial surface has a
small, comma-shaped
articular facet for
articulation with the
medial malleolus of the
tibia.
Talus
• The posterior surface is marked by two small
tubercles, separated by a groove for the flexor
hallucis longus tendon.
Navicular Bone
• The tuberosity of the navicular bone can be seen and felt
on the medial border of the foot 1 in. (2.5 cm) in front of
and below the medial malleolus.; it gives attachment to
the main part of the tibialis posterior tendon.
Cuboid Bone
• A deep groove on the inferior aspect of the cuboid bone
lodges the tendon of the peroneus longus muscle.
Cuneiform Bones
• The three small, wedge-shaped cuneiform bones
articulate proximally with the navicular bone and
distally with the first three metatarsal bones.
• Their wedge shape contributes greatly to the formation
and maintenance of the transverse arch of the foot.
Metatarsal Bones and Phalanges
• The metatarsal bones
and phalanges resemble
the metacarpals and
phalanges of the hand,
and each possesses a
head distally, a shaft,
and a base proximally.
• The five metatarsals are
numbered from the
medial to the lateral
side.
Metatarsal Bones and Phalanges
• The first metatarsal
bone is large and strong
and plays an important
role in supporting the
weight of the body.
Metatarsal Bones and Phalanges
• On the plantar surface
of the head of the first
metatarsal bone, there
are prominent medial
and lateral sesamoid
bones.
Metatarsal Bones and Phalanges
• The fifth metatarsal has
a prominent tubercle
on its base that can be
easily palpated along
the lateral border of the
foot.
Metatarsal Bones and Phalanges
• The tubercle gives
attachment to the
peroneus brevis
tendon.
Metatarsal Bones and Phalanges
• Each toe has three
phalanges except the big
toe, which possesses only
two.