Bones of lower limb By DR N SATYANARAYANA.

Bones of lower limb Hip bone Femur Tibia Fibula Patella Tarsal bones Metatarsal bones Phalanges

Hip bones

Flat bones, form bony pelvis along with sacrum and coccyx Posteriorly articulate with the sacrum at the sacroiliac joint Anteriorly articulate with each other at a joint called pubic symphyses Contains 3 parts – pubis, ilium and ischium

Bony pelvis - formed by sacrum, coccyx and pair of hip bones coccyx sacrum Hip bone Pubic symphysis Obturator foramen Acetabulum

Ilium of Hip bone – lateral view Anterior superior iliac spine Anterior inferior iliac spine Posterior inferior iliac spine Posterior superior iliac spine Tuberosity of iliac crest Iliac crest Obturator foramen Acetabulum Posterior Anterior Anterior border Posterior border Gluteal surface Gluteal lines

Ileum of hip bone – medial view Anterior superior iliac spine Anterior inferior iliac spine Auricular surface (articulates with Sacrum to form Sacroiliac joint) Anterior Posterior Iliac tuberosity Pelvic surface Medial border Iliac fossa

Ischium of hip bone – lateral view Greater sciatic notch Lesser sciatic notch Ischial spine Ischial tuberosity Obturator foramen Posterior Anterior Body of ischium Ramus of ischium

Pubis of hip bone Body Medial surface Anterior surface Posterior surface Superior ramus Pubic crest Pubic tubercle Pecten pubis Iliopubic eminence Obturator crest Inferior ramus

Acetabular margin Acetabular notch Lunate surface Acetabular Fossa Acetabulum Is a depression situated on the lateral aspect of hip bone Forms hip joint with head of femur Is bounded by acetabular margin On the inferior aspect the margin is absent and contains acetabular notch Has 2 parts – Lunate surface – articular area Acetabular fossa – filled with acetabular pad of fat

Iliacus Sartorius Rectus femoris Pectineus Adductor longus Gracilis Adductor brevis Obturator externus Adductor magnus

Gluteus maximus Gluteus minimus Gluteus medius Tensor fasciae latae Sartorius Rectus femoris Adductor magnus Semitendinosus and long head of biceps femoris Semimembranosus Quadratus femoris Gamellus superior Gamellus inferior

Ilium: Upper expanded bony plate Has iliac crest and 3 borders – anterior, posterior and medial 3 surfaces: gluteal surface, iliac fossa and sacropelvic surface Iliac crest: Is the upper end of ilium Gives attachment to external abdomnis, internal abdomnis, transversus abdominis, errector spinae, gluteus maximus, latissimus dorsi, quadratus lumborum muscles Presents rough area called tubercle (tubersoity) of iliac crest near the anterior end which gives attachment to iliotibial tract

Anterior border presents: Anterior superior iliac spine – gives attachment to inguinal ligament and sartorius muscle Anterior inferior iliac spine – gives attachment to iliofemoral ligament and rectus femoris muscle Posterior border presents posterior superior iliac spine and posterior inferior iliac spine Medial border separates the iliac fossa and sacropelvic surfaces

Gluteal surface: Is the outer surface, divided into 4 areas by 3 gluteal lines (posterior, anterior and inferior gluteal lines) Gives attachment to gluteus maximus, gluteus medius, gluteus minimus and rectus femoris muscles Iliac fossa:(medial aspect). Concave area on the medial aspect of ilium, gives attachment to iliacus muscle Sacropelvic surface: :(medial aspect). Situated on the medial aspect of ilium Presents 3 parts – Iliac tuberosity which gives attachment to interosseus sacroiliac ligament Articular (auricular) surface for sacrum to form sacroiliac joint Pelvic surface form the wall of pelvic cavity

Ischium: Is the posterior and inferior part of hip bone Has a body, ischial tuberosity, ischial spine, ramus of ischium, greater and lesser sciatic notches. Ischial tuberosity: Rough area which gives attachment to semitendinosus, semimembranosus, long head of bicpes femoris, adductor magnus muscles and sacrotuberous ligament Ischial spine: Gives attachment to sacrospinous ligament, levator ani, cocygeus muscles Greater sciatic notch is above the ischial spine and lesser sciatic notch is below the ischial spine Ramus of ischium: Joins the inferior ramus of pubis and forms conjoined ischiopubic ramus Gives attachment to adductor magnus muscle

Pubis: Anterior and inferior part of hip bone It has body, superior ramus and inferior ramus Body: Has superior border 3 surfaces – anterior, posterior and medial Superior border: Is called pubic crest At its lateral end presents pubic tubercle which gives attachment to inguinal ligament Anterior surface: Gives attachment to muscles of medial compartment of thigh (adductor longus, gracilis, adductor brevis and obturator externus)

Posterior surface: Forms the anterior wall of pelvic cavity Medial surface: Articulates with opposite pubic bone to form a joint called pubic symphysis Inferior ramus: Joins the ramus of ischium to form conjoined ischiopubic ramus Gives attachment to adductor magnus and adductor brevis muscles Superior ramus: Presents –Pectineal line (pecten pubis) –Iliopubic eminence –Obturator crest Superior ramus gives attachment to pectineus muscle

Femur

Bone of thigh region and longest bone in the body Contains shaft, upper and lower ends Upper end presents – Head, neck, greater and lesser trochanters Intertrochanteric line and intertrochanteric crest Head: Articulates with acetabulum of hip bone to form hip joint Contains fovea capitis which gives attachment to ligament of head of femur Neck: Connects head with shaft, 1.5 inches long

Lower end Upper end Shaft Femur – Posterior view Femur – Anterior view Linea Aspera Lateral Supra- condylar line

Trochanteric fossa Gives attachment to: Gluteus medius Gluteus minimus Piriformis Obturator internus Superior gamellus Inferior gamellus Obturator externus Gives attachment to: Iliacus Psoas major Ligament of head of femur Upper end of femur – anterior view

Fovea capitis (Pit for ligament of head of femur) Head of femur

Linea aspera Spiral line Gluteal tuberosity Upper end of femur – posterior view

Lower end of femur – Anterior view Lower end of femur – Posterior view

Right femur – anterior view Vastus intermedius Articularis genu Adductor magnus Gluteus minimus Piriformis Obturator internus, superior gamellus, inferior gamellus

Right femur – posterior view Gluteus medius Quadratus femoris Vastus lateralis Vatus medialis Iliacus and psoas major Pectineus Adductor brevis Adductor longus Gluteus maximus Adductor magnus Gastrocnemius (medial head) plantaris Gastrocnemius (lateral head) Popliteus

Greater trochanter: Large projection situated on the lateral aspect of femur at the junction of neck and shaft Gives attachment to many muscles Apex - piriformis muscle Anterior surface – gulteus minimus Lateral surface – gluteus medius Medial surface – obturator internus, superior gamellus and inferior gamellus Medial surface presents trochanteric fossa which gives attachment to obturator externus muscle

Lesser trochanter: Small projection situated on the medial aspect of femur at the junction of neck and shaft Gives attachment to iliacus and psoas major muscles Intertrochanteric crest: Situated on the posterior aspect of femur at the junction of neck and shaft, connecting 2 trochanters Presents quadrate tubercle which gives attachment to quadratus femoris muscle Intertrochanteric line: Situated on the anterior aspect of femur at the junction of neck and shaft Continuous inferiorly with spiral line

Lower end: contains – Medial and lateral condyles, intercondylar fossa Medial condyle: On its medial aspect presents –Adductor tubercle – gives attachment to adductor magnus muscle –Medial epicondyle – gives attachment to tibial collateral ligament of knee joint Lateral condyle: On its lateral aspect presents –Lateral epicondyle which gives attachment to fibular collateral ligament of knee joint –Popliteal groove which gives attachment to popliteus muscle Anterior surface of two condyles articulate with patella Inferior and posterior surfaces of 2 condyles articulate with condyles of tibia Intercondylar fossa (intercondylar notch): Situated on the posterior aspect of lower end, between the 2 condyles

Shaft: Has 3 borders and 3 surfaces in the middle part Borders – medial, lateral and posterior Surfaces – anterior, medial and lateral Posterior border is very prominent in the middle one-third of shaft and is linea aspera Linea aspera has 2 lips – medial and lateral lips Medial lip will continue upwards as spiral line and lateral lip will continue upwards as gluteal tuberosity Medial and lateral lips continues downward as medial and lateral supracondylar lines At the lower one-third the shaft contains 4 surfaces – anterior, medial, lateral and popliteal surface At the lower one-third the shaft contains 4 surfaces – anterior, medial, lateral and posterior surface

Anterior surface and lateral surface give attachment to vastus intermedius muscle Lateral lip of linea aspera gives attachment to vastus lateralis Medial lip of linea aspera and spiral line gives attachment to vastus medialis Intermediate area of linea aspera gives attachment to adductor longus, adductor magnus, adductor brevis muscles Gluteal tuberosity gives attachment to gluteus maximus muscle Medial supracondylar line gives attachment to adductor magnus Lateral supracondylar line gives attachment to plantaris muscle Posterior surface gives attachment to petineus and adductor brevis muscles

Patella Largest sesamoid bone, develops in the tendon of quadriceps femoris muscle Situated at the knee, in front of medial and lateral condyles of femur Triangular shaped has – base, apex, anterior and posterior surfaces Base directed upwards, gives attachment to tendon of quadriceps femoris muscle Apex directed downwards, gives attachment to ligamentum patellae or patellar ligament Posterior surface presents articular areas for medial and lateral condyles of femur Articular area for lateral condyle is larger than ther articular area for medial condyle

Patella Base Anterior view Posterior view

Tibia

Right tiba (anterior view) Medial condyle Lateral condyle Articular area for head of fibula Tibial tuberosity Intercondylar eminence Anterior border Medial surface Lateral surface Lateral border Medial border Lower end Medial malleolus

Right tibia – posterior view Groove for semimembranosus Intercondylar eminence Superior surface of medial condyle Lateral condyle Facet for head of fibula Posterior surface of shaft Soleal line Lateral border Medial border Lower end Medial malleolus

Tibia upper end – superior surface Articular area for medial condyle of femur Articular area for lateral condyle of femur Posterior intercondylar area Anterior intercondylar area Anterior end of medial meniscus Anterior end of lateral meniscus Anterior cruciate ligament Posterior cruciate ligament Posterior end of medial meniscus Posterior end of lateral meniscus Posterior Anterior

Anterior ends of medial and lateral menisci Posterior ends of medial and lateral menisci Anterior cruciate ligament Posterior cruciate ligament Tibial collateral ligament

Tibia – lower end

Tibia – anterior view Tibialis anterior Sartorius, semitendinosus, gracilis Iliotibial tract

Tibia – posterior view Soleus Semimembranosus Popliteus Extensor digitorum longus Tibialis posterior

Tibia Medial bone of the leg Has – shaft, upper and lower ends Upper end: Presents medial and lateral condyles, tibial tuberosity and intercondylar area Tibial tuberosity is present on the anterior aspect presents of upper end, gives attachment to ligamentum patella (patellar ligament) Lateral condyle on its lateral aspects presents an articular facet for head of fibula Medial condyle on its posterior aspect presents a groove for the attachment of semimembranosus muscle Superior surfaces of lateral and medial condyles contain smooth articular areas for lateral and medial condyles of femur

Intercondylar area: Situated on the superior surfaces of upper end, between the articular areas for femur Divided into anterior and posterior intecondylar areas by the intercondylar eminence Anterior intercondylar area gives attachment to anterior cruciate ligament, anterior ends of medial and lateral menisci Posterior intercondylar area gives attachment to posterior cruciate ligament, posterior ends of medial and lateral menisci

Lower end: Presents a presents a projection on the medial side called medial malleolus Inferior surface of lower end and medial malleolus articulate with talus

Shaft Shaft has 3 borders and 3 surfaces Borders – anterior, medial and lateral (interosseous) Surfaces – medial, lateral and posterior Anterior border is very prominent and called shin of the tibia Medial surface is subcutaneous Medial surface in the upper part gives attachment to muscles of sartorius, gracilis and semitendinosus muscles Lateral surface gives attachment to tibialis anterior muscle Posterior divided in to upper and lower parts by a ridge called soleal line which gives attachment to soleus muscle Upper part of posterior surface gives attachment to popliteus Lower part of posterior surface gives attachment to tibialis posterior and flexor digitorum longus

fibula

Right fibula (anterior view) Lateral condyle Head Lateral surface Anterior border Medial border Shaft Anterior surface Lateral malleolus Neck

Right fibula – posterior view Head of fibula Posterior border Lateral malleolus Lateral suface Posterior surface Malleolar fossa

Right Fibula – anterior view Externsor hallucis longus Extensor digitroum longus Biceps femoris Peroneus tertius Peroneus longus Peroneus brevis

Right fibula – posterior view Soleus Extensor hallucis ongus Tibialis posterior

Fibula Is a lateral bone of leg Has a shaft, upper and lower ends Upper end: Upper end is called head, expanded in all directions Upper surface of head presents a smooth area which articulates with lateral condyle of tibia Head gives attachment to biceps femoris and soleus muscles, fibular collateral ligament Lower end: Is flat and called lateral malleolus Its medial aspect presents –smooth, triangular articular area for talus –depression called malleolar fossa which gives attachment to inferior transverse tibiofibular ligament

Shaft Narrow upper part of the shaft near the head is called neck and related to common peroneal nerve Shaft has 3 borders and 3 surfaces Borders – anterior, medial (interosseous) and posterior Surfaces – anterior, lateral and posterior Anterior surface gives attachment to muscles of anterior compartment of leg (extensor digitorum longus, extensor hallucis longus and peroneus tertius) Lateral surface gives attachment to muscles of lateral compartment of leg (peroneus longus and brevis) Posterior surface gives attachment to muscles of posterior compartment of leg (soleus, tibialis posterior, flexor hallucis longus) Lower part of posterior surface presents a ridge called peroneal (medial) crest

Bones of foot Foot contains tarsal bones, metatarsal bones and phalanges Tarsal bones are 7 in number Talus, calcaneum, cuboid, navicular, medial, lateral and intermediate cuneiform bones Talus is involved in the formation of ankle joint Calcaneum is the largest tarsal bone, it is situated below the talus Calcaneum presents sustentaculum tali on its medial aspect Calcaneum presents medial and lateral tubercles on its inferior aspect Subtalar joint is between talus and calcaneum Anterior end (head) of talus forms talocalcaneo-navicular joint with calcaneum and navicular bones Anterior end of calcanuem forms calcaneocuboid joint with cuboid Talocalcaneo-navicular and calcaneocuboid joints are together known as midtarsal joints

Right Foot (superior view) First metatarsal bone Talus Calcaneum Navicular Medial cuneiform Intermediate cuneiform Lateral cuneiform Cuboid Phalanges

Calcaneum Talus Navicular Medial cuneiform Intermediate cuneiform Right Foot – medial view Medial tubercle of calcaneum Talocalcaneo- navicular joint Sustentaculum tali

Calcaneum Talus Cuboid Right Foot - lateral view 4 th and 5 th metatarsal bones Lateral tubercle of calcaneum Calcaneocuboid joint Subtalar joint