Pubis, ischium, ilium Ð form pelvic brim, and above this ilium flat broad attachments.
- strong sacroiliac ligaments behind bear the body weight.
- Ischium and pubis on some plane; ilium nearly at right angles.
Acetabulum is the hip joint socket. Concave hemisphere, direct down and slightly back.
- acetabular notch inferiorly
- hyalin cartilage, thickest opposite this notch (WBing part)
Iliopubic eminence = where pubis and ilium meet.
- ilium & ischium meet under arcuate line posterior of acetabulum
Iliac crest extends from ASIS to PSIS, tubercle lying 5cm behind ASIS (most lateral part)
- the highest part is more posterior, marks spine of L4
- Anterior inferior iliac spine is inferior, where straight head of rectus & iliofemoral lig attach.
Posterior iliac crest is thick, where posterior lumbar fascia and erector spinae arise
Body of pubis:
quadralateral; superior rami join
ilium and ischium at acetabulum;
- inferior rami fuse with ischium below the obturator foramen
- upper border = convex pubic crest; with forward projecting pubic crest.
- Two ridges (upper ramus): pectineal line along pelvic brim (iliopubic eminence at its end), and lower rounded obturator crest (with obturator groove below)
Ischium is L-shaped, upper thick body, joins pubis and ilium at acetabulum then ¨ ischial tuberosity.
- joins inferior ramus to enclose obturator foramen.
- Ischiofemoral ligament attaches at margin or acetabulum
- Medially ischium body completes the greater sciatic notch (sciatic nerve & n. to quatratus femoris lie here on the ischium)
- Spine projects medially dividing greater from lesser sciatic notch. Sacrospinous ligament attaches to it, forming the greater sciatic foramen.
- Sacrotuberous ligament bridges to lesser notch to form lesser sciatic foramen.
Ischial tuberosity: rugged prominence on posterior ischium.
Obturator foramen: ringed by sharp margins of pubis and ischium.
Inner surface: smooth
Ossifies in cartilage: three centres, one for each bone, near acetabulum.
- centre for ilium first (its weight bearing) followed by ischium (3rd month fetus) and pubis.
At birth acetabulum is wholly cartilage, ilium is broad bone, ischium & pubis are tiny bars.
Ischial and pubic rami fuse at 7 years.
Secondary centres appear in acetabulum at 18 years, compete by 18 years.
All of bone fused by 25 years.
See paper notes
Sesamoid in quads tendon; plays on articular surface of femur.
Edges form a rounded triangle: lower border = apex
Posterior surface = proximal articular area (hyaline covered)
- vertical ridge divides ¨ narrow medial and broader lateral areas
- narrow medial divided also into 2 vertical strips
- medial facet ¨ femoral condyle inly in flexion; lateral ¨ lateral condyle throughout.
When standing lower border is = just proximal to the level of the knee joint.
Bone ossifies in several centres from 3-6 years, coalesce quickly
- bipartite patella may result from lack of complete fusion.
Massive medial and lateral condyles and a small lower end
Shaft vertical ¨ femur inclines outwards above it.
Superior articular surface: concave condylar articular areas ¨ menisci & femoral condyles
- medial condyle surface is oval, conforms with medial femoral condyle and meniscus
- lateral smaller, nearly circular.
- Intercondylar eminence between, grooved AP ¨ intercondylar tubercles
Tuberosity: smooth oval prominence for quads; rough inferior area covered by infrapatellar bursa.
Shaft: anterior and posterior borders, medial surface between
- interosseus border on fibular side ¨ membrane
Soleal line: obliquely across surface just below tibiofibular joint
- nutrient artery enters shaft surface of fibular side (upper part)
Lower: rectangular in section, extends down as medial malleolus.
Incise over tibialis anterior, detach it.
Do not incise over the bone itself as healing over muscle is better.
Posteromedial: along posterior border of bone, detaching soleus and FDL.
Posterolateral: open up b/n peroneus longus & soleus, identifying peroneal nerve; strip tib post.
Ossifies in cartilage, primary centre appears in 8th week
Upper epiphysis growing end) centre immediately after birth; fused by 20 years.
Medial malleolus is an extension from lower epiphysis.
Slender shaft ¨ quadrilateral head ¨ flat malleolus
Head: oval facet proximally and medially ¨ reciprocal facet on upper tibia
- styloid process extends up
Shaft: 3 surfaces: anterior, lateral, posterior; concord with 3 leg compartments.
- common peroneal nerve enters peroneus longus at neck of the bone; can be damaged here
- medial crest divides posterior surface into medial and lateral parts
- malleolar fossa behind is perforated by foramina.
Lateral: along interval between peroneus longus and soleus, using common peroneal nerve to guide.
Cartilage by a centre in shaft, appears in eight week.
Epiphysis at each end
Head grows, ossifies later (4th year) and lower (2nd year) fuses with shaft at 20 and 18 respectively.
Tarsus: 7 bones in proximal (talus and calcaneus) and distal rows
- only calcaneus rests on the ground.
Largest tarsal bone, rectangular block with distinctive sustentaculum shelf projecting from upper border of its medial surface.
Upper: carries articular facets on anterior half.
Posterior: smooth upper part for Achilles, lower convex for plantar aponeurosis.
Inferior: tuberosity posteriorly; weight bearing part.
Anterior: ¨ cuboid
Lateral lat, but small ridge of peroneal trochlea from which peroneal retinaculum bridges the sheathed tendons of peroneus brevis bin groove above and longus below.
Medial: concave, above the sustentaculum tali projects, deeply grooved in undersurface by FDL in sheath.
Carries whole body weight.
Body: carries an articular area (trochlea) .
- vascular foramina run behind lamina of deltoid ligament
- posterior process lies behind talus
On either side are medial and lateral tubercles for attachments
Inferior: concave oval facet ¨ calcaneus
Head: ball for socket (see joint)
No muscles are attached to talus, but good anastomotic blood supply within bone from branches of dorsalis pedis, posterior tibial and peroneal arteries
- intraosseous vessels run mainly anterior ¨ posterior
- #s of talar neck can ¨ avascular necrosis if displaced.
Narrowest laterally, broadest medially; ¨ 4th, 5th metatarsals, lateral cuneiform & maybe navicular.
Medial: facet for lateral cuneiform, small facet for navicular
Dorsa: bare
Lateral: notch and grooved by peroneus longus tendon.
- a prominent ridge forms the posterior margin of the groove; deep fibres of long plantar ligament attach to this ridge, while superficial fibres cross the groove = fibro-osseous tunnel: lodges peroneus longus tendon and its sheath.
Boat shaped, prominent medial tuberosity = prow.
Tuberosity = 2.5cm below and anterior to medial malleolus ¨ tibialis posterior.
3, all wedge-shaped.
Medial = largest, intermediate = smallest.
All ¨ navicular, and a metatarsal; completing medial longitudinal arch.
First = thick, transmits propulsive thrust;
2nd-5th = slender shafts
Heads united by deep transverse ligaments.
Base of 5th is prominent, lateral to cuboid joint; receives tendon of peroneus brevis and peroneus tertius.
2 for great toe, three for others.
Each MTP jt is strengthened by thick fibrocartilage (plantar ligament)
- four short bands unite plantar ligaments of adjoining MTP jts = transverse metacarpal ligament
Ossify in cartilage
Three bones of tarsus = ossified at birth (calcaneus first, talus, then cuboid)
- navicular and cuneiforms ossify during first four years
Metatarsal and phalanges ossify by shaft centres in utero, epiphyses as in hand.
Secondary centres for posterior calcaneus and sometimes lateral tubercle of talus arise, also for tubercle to base of 5th metatarsal and tuberosity of navicular.