1. 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

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

3. Pelvic girdle

6. 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

8. 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, gretaer sciatic notch,iliac fossa,arcuate line and the pelvic

10. Lateral view

11. Medial View

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

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

14. Lateral and Medial Views of the Hip Bone

15. 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

16. True and False Pelves

17. 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

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

19. 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

20. 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

21. Structures of the Femur

22. 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

23. 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

24. 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

25. 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)

26. Structures of the Tibia and Fibula

27. Anterior view

28. posterior view

29. 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

30. 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

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

32. 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

33. Bones of the Foot

36. 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

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

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

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

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

44. 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.

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

47.  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.

48. 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

49. 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

50. 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

51. 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:

52. 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

53. 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

55. 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

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

58. Unhappy triad(TCL,MEDIAL MENISCUS AND ACL)

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

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

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

63. 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

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

66. Medial ligament of the ankle joint (Deltoid ligament)

67.  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)

68. Lateral ligament of the ankle joint.

69. 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.

70. 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.

71. 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.

72. Arches of the foot.

74. 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.

75. 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).

76. Support for arches of the foot

77. 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

78. 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).

79. Genu Varum and Genu Valgum

80. The Q-angle

81. 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

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