Pelvic girdle  Attaches lower limbs to the spine  Supports visceral organs  Attaches to the axial skeleton by strong ligaments  Acetabulum is a deep cup that holds the head of the femur

Pelvic girdle  Consists of paired hip bones (coxal bones)  Hip bones unite anteriorly with each other  Articulates posteriorly with the sacrum

Pelvic girdle

Hip bones  Consist of three separate bones in childhood  Ilium, ischium, and pubis  Bones fuse – retain separate names to regions of the coxal bones  The triradiate cartilage  Acetabulum  A deep hemispherical socket on lateral pelvic surface

ilium  The ilium is a large flaring bone that forms the superior region of the coxal.  It consists of a body and superior wing like portion called the ala  The broad posterolateral surface is called the gluteal surface  The auricular surface articulates with the sacrum (sacroiliac joint)  Major markings include the iliac crests, four spines, greater sciatic notch, iliac fossa, arcuate line

Lateral view

Medial View

Ischium  Forms posteroinferior region of the coxal bone  Anteriorly – joins the pubis  Ischial tuberosities  Are the strongest part of the hip bone

Pubis  Forms the anterior region of the coxal bone  An angulated bone  Lies horizontally in anatomical position  Pubic symphysis (fribrocartilage)

Lateral and Medial Views of the Hip Bone

True and False Pelves  Bony pelvis is divided into two regions  False (greater) pelvis – bounded by alae of the iliac bones  True (lesser) pelvis – inferior to pelvic brim  Forms a bowl containing the pelvic organs

True and False Pelves

Comparison of Male and Female Pelvic Structure  Female pelvis  –Tilted forward, adapted for childbearing  –True pelvis defines birth canal  –Cavity of the true pelvis is broad, shallow, and has greater capacity

 Male pelvis  –Tilted less forward  –Adapted for support of heavier male build and stronger muscles  –Cavity of true pelvis is narrow and deep

CharacteristicFemaleMale Bone thicknessLighter, thinner, and smoother Heavier, thicker, and more prominent markings Pubic arch/angle80°–90°50°–60° AcetabulaSmall; farther apartLarge; closer together SacrumWider, shorter; sacral curvature is accentuated Narrow, longer; sacral promontory more ventral CoccyxMore movable; straighterLess movable; curves ventrally

Thigh  The region of the lower limb between the hip and the knee  Femur – the single bone of the thigh  Longest and strongest bone of the body  Ball-shaped head articulates with the acetabulum

femur  Longest bone in the body  Heaviest bone  Has a head with a fovea called pit  Proximal end has two trochanters (greater and lesser)  Neck is trapezoidal  angle of inclination between the long axis of the head and the proximal end and the shaft

Femur cntd  Lesser trochanter is posterior medial (flexors of thigh)  Greater trochanter is lateral(abductors and rotators of thigh)  Intertrochanteric line (iliofemoral ligament)  Intertrochanteric crest  Quadrate tubercle and trochanteric fossa  Shaft is smooth anteriorly and convex  Posteriorly the shaft has a linea aspera

Femur contd  Medial and lateral condyles  Intercondylar fossa  Patella surface  Medial and lateral epicondyle  Adductor tubercle

Structures of the Femur

Patella  Triangular sesamoid bone  Imbedded in the tendon that secures the quadriceps muscles  Protects the knee anteriorly  Improves leverage of the thigh muscles across the knee

Leg  Refers to the region of the lower limb between the knee and the ankle  The leg is fixed in permanent pronation  Composed of the tibia and fibula  Tibia – more massive medial bone of the leg  Receives weight of the body from the femur  Fibula – stick-like lateral bone of the leg  Interosseous membrane- Connects the tibia and fibula

tibia  Has 2 condyles- medial and lateral  Intercondylar eminence  Shaft has 3 surfaces- medial, lateral and posterior  Anterior border is most prominent and also called the shin or shin bone  Extends distally to form the medial malleolus  Fibular notch  Posterior surface has a soleal line  Nutrient foramen

Structures of the Tibia and Fibula

fibula  Lies posteriolateral  Leg is fixed in permanent pronation  Distal end ends in lateral malleolus  Shaft has 3 borders (anterior, posterior and interosseous) and 3 surfaces (medial, posterior and lateral)

Anterior view

posterior view

The Foot  Foot is composed of  Tarsus, metatarsus, and the phalanges  Important functions  Supports body weight  Acts as a lever to propel body forward when walking  Segmentation makes foot pliable and adapted to uneven ground

Tarsus  Makes up the posterior half of the foot  Contains seven (7)bones called tarsals  Talus, calcaneous, cuboid, navicular, 3 cuneiforms  Body weight is primarily borne by the talus and calcaneus

Metatarsus  Consists of five small long bones called metatarsals  Numbered 1–5 beginning with the hallux (great toe)  First metatarsal supports body weight

Phalanges of the Toes  14 phalanges of the toes  Smaller and less nimble than those of the fingers  Structure and arrangement are similar to phalanges of fingers  Except for the great toe, each toe has three phalanges  Proximal, middle, and distal

Bones of the Foot

fractures of the femur  Mostly age and sex related (elderly females >60) due osteoporosis  Most common site is the neck  Proximal femoral fractures  Transcervical fracture-femoral neck (avascular necrosis occurs due to retinacular arteries that are cut off from the medial circumflex femoral artery)  Inter trochanteric fracture  Femoral shaft fracture  spiral fracture (leads to foreshortening)  Distal femoral fractures  Fracture of femoral condyles- popliteal artery runs on the posterior surface

Fractures of tibia and fibula

Tibial and fibula fracture  The tibial shaft is narrowest at the junction of its middle third and inferior thirds and most frequent site of fracture.  Poor blood supply  nutrient artery (nutrient canal posteriorly)  Types  Compound fracture (with external bleeding)  Diagonal fracture with shortening  Transverse fractures (with fibular intact)  March (stress) fracture

Fibula neck fracture Direct trauma as nerve passes superficially around neck of fibula Foot drop and loss of eversion May cause sensory loss over lateral leg and dorsum of foot

Fracture of Lateral malleolus Fibular malleolar fracture effect- excessive inversion of foot Common in soccer and football players

HIP JOINT, KNEE JOINT and ANKLE JOINT  Type  Articulation  Capsule  Ligaments  Movements  Blood Supply  Nerve Supply

Hip Joint  The hip joint forms the connection between the lower limb and the pelvic girdle

HIP JOINT  TYPE: BOLL & SOCKET TYPE  ARTICULATIONS : Cup shaped acetabulum & Hemi spherical head of femur Acetebular surface is horseshoe shaped Cavity is deepended by – fibro cartilagenous rim called “ Acetabular labrum”

LIGAMENTS 5 IN NO. 1.ILIO-FEMORAL LIGAMENT: - Strong, inverted “y” shaped Lig. - Base is above – from AIIS - 2 limbs are below from – upper & lower parts of Inter – trochanteric line 2. PUBO - FEMORAL LIGAMENT: - Triangular in shape Base – superior ramus of pubis Apex – Lower part of Inter trochanteric line Limits – extension & abduction

3. ISCHIOFEMORAL LIGAMENT : - Spiral shaped ligament - Acetabular margin of Ischium & greater trochanter - limits extension 4. TRANSVERS ACETABULAR LIGAMENT: - formed between the acetabular labrum ends - Bridges the acetabular notch 5. Lig. OF HEAD OF FEMUR: - Flat, triangular ligament - apex – pit on the head of femur - base – transvers Lig. & acetabular margins

MOVEMENTS:  FLEXION:  EXTENSION:  ABDUCTION:  ADDUCTION:  LATERAL ROTATION:  MEDIAL ROTATION:  CIRCUMDUCTION:

Blood Supply of the Hip Joint  The medial and lateral circumflex femoral arteries  The artery to the head of the femur

Avscular Necrosis of head  More common >60 years  In female for osteoporosis  Supplied mainly by Medial circumflex femoral artery by its retinacular branches  Blood supplied through round ligament of femur(br. Of Obturator) is grossly inadequate.

Hip Joint Replacement  A metal prosthesis anchored to femur by bone cement  A plastic socket is cemented to acetabulum

 Posterior dislocation  Posterior tearing of joint capsule  Dislocated femoral head lies on posterior surface of ischium  Occurs in head-on collision  Complications  Sciatic nerve may damage.

POSTEIOR DISLOCATION of hip joint can lead to sciatic nerve injury. Most common manifestation is foot drop due to damage to common fibular part Relatively Rare phenomena

KNEE JOINT  TYPE : Femoro-Tibial joint – Synovial joint of Hinge variety Patello-Femoral joint – Synovial joint of gliding variety. ARTICULATIONS : 1. Femoro-Tibial joint : Above – Femoral condyles Below – Tibial condyles & their Cartilaginous menisci 2. Patello-Femoral joint : Above – Posterior surface of patella Below – Patellar surface of lower end of femur The articular surfaces are lined with Hyaline cartilage

LIGAMENTS I. EXTRACAPSULAR LIGAMENTS: 1. Ligamentum patellae:- Attachments Above – Lower border of patella Below – Tibial tuberosity It is a continuation of the central portion of common tendon of Quadriceps femoris 2. Lateral collateral ligament: card like above – Lateral condyle of femur below – Head of fibula

3. Medial collateral ligament : is flat band like above – Medial condyle of femur below – medial surface of shaft of tibia It is firmly attached to the edge of the medial meniscus I. EXTRACAPSULAR LIGAMENTS:

II.INTRACAPSULAR LIGAMENTS: CRUCIATE LIGAMENTS: * Main lig.’s Bound between femur & tibia throughout joint range. 1.A.C.L. Attachments: below – Anterior intercondylar area of tibia above – posterior part of medial surface of lateral femoral condyle It prevents forward displacement of Tibial condyles

2.P.C.L.:- Attachments: below – posterior inter condylar area of tibia above – anterior part of lateral surface of medial femoral condyle It prevents backward displacement of tibial condyles and anterior displacement of femur on the tibia It prevents posterior pulling of tibia when the knee is flexed

3.Medial Meniscus and 4.Lateral Meniscus  “C” shaped fibro cartilaginous sheets  Peripheral border is thick & attached to capsule  Inner border is thin, concave & free  Upper surface – in contact with femoral condyles  Lower surface – in contacts with tibial condyles  Function : Shock absorbing cushion between two bones

MOVEMENTS:  FLEXION  EXTENSION  MEDIAL ROTATION  LATERAL ROTATION

Unhappy triad(TCL,MEDIAL MENISCUS AND ACL)

Knee Joint Injuries  Anterior drawer sign: This injury causes the free tibia to slide anteriorly under the fixed femur.

Posterior drawer sign:  PCL ruptures allow the free tibia to slide posteriorly under the fixed femur.

BURSAE:  ANTERIOR SIDE: 1. SUPRA PATELLAR BURSA 2. PRE - PATELLAR BURSA 3. INFRA PATELLAR BURSA i). Superficial ii). Deep

Bursitis in the Knee Region  1. Prepatellar bursitis: Prepatellar bursitis is caused by friction between the skin and the patella. This condition has been called housemaid's knee.

Subcutaneous infrapatellar bursitis  caused by excessive friction between the skin and the tibial tuberosity.

 Baker's Cyst  Posterior herniation of synovial membrane through joint capsule into popliteal fossa  Usually asymptomatic but Large swellings may interfere with knee movements

ANKLE JOINT  TYPE : – Synovial joint of Hinge variety. ARTICULATIONS : Above – Lower end of tibia and fibula Below – Body of talus The articular surfaces are lined with Hyaline cartilage

LIGAMENTS Medial or Deltoid ligament:  1.Posterior tibiotalar  2.Anterior tibiotalar  3.Tibionavicular  4. Tibiocalcaneal 3 4 5

Medial ligament of the ankle joint (Deltoid ligament)

 Lateral ligament of the ankle joint  1.Posterior talofibular  thick strong lig. (malle.fossa to lat.tubercle of talus)  2.Anterior talofibular  weak  3.calcaneofibular ligament round cord (lat. Mall to Lat.surface of calcaneus)

Lateral ligament of the ankle joint.

MOVEMENTS of the Ankle Joint  1. Dorsiflexion of the ankle  2. Plantarflexion of the ankle  The movements of inversion and eversion take place at the tarsal joints and not at the ankle joint.

Clinical Anatomy

Ankle Injuries  The lateral ligament is injured because it is much weaker than the medial ligament.  The anterior talofibular ligament part of the lateral ligament is most vulnerable and most commonly torn during ankle sprains.

Pott fracture(dislocation of the ankle)  Occurs when the foot is forcibly everted.  Trimalleolar fracture:  The combined fracture of the medial malleolus, lateral malleolus, and the posterior margin of the distal end of the tibia is known as a "trimalleolar fracture

Arches of the Foot  The bones of the foot do not lie in a horizontal plane. Instead, they form longitudinal and transverse arches relative to the ground.  The arches distribute weight over the pedal platform (foot), acting not only as shock absorbers but also as springboards for propelling it during walking, running, and jumping.

Longitudinal arch  The longitudinal arch of the foot is formed between the posterior end of the calcaneus and the heads of the metatarsals.  It is highest on the medial side where it forms the medial part of the longitudinal arch and lowest on the lateral side where it forms the lateral part.

Arches of the foot.

Transverse arch  The transverse arch of the foot runs from side to side  It is formed by the cuboid, cuneiforms, and bases of the metatarsals. The medial and lateral parts of the longitudinal arch serve as pillars for the transverse arch.

Major Ligaments of the Foot  1. Plantar calcaneonavicular ligament (spring ligament): The spring ligament supports the head of the talus and plays important roles in the transfer of weight from the talus and in maintaining the longitudinal arch of the foot, of which it is the keystone (superior most element).  2. Long plantar ligament  3. Plantar calcaneocuboid ligament (short plantar ligament).

Support for arches of the foot

Clinical Anatomy  1.Hallux Valgus:  Hallux valgus is a foot deformity caused by pressure from footwear and degenerative joint disease; it is characterized by lateral deviation of the great toe

Flatfeet  Flatfeet can either be flexible (flat, lacking a medial arch, when weight bearing but normal in appearance when not bearing weight or rigid (flat even when not bearing weight).

Genu Varum and Genu Valgum

The Q-angle

Genu varum  Genu varum (also called bow-leggedness), is a physical deformity marked by (outward bowing) of the leg in relation to the thigh, giving the appearance of an archer's bow.deformitylegthigh bow

Genu valgum  Genu valgum, commonly called "knock-knees", is a condition where the knees touch one another when the legs are straightened.kneeslegs