1. Bones of the Hip

2. Ilium Iliac fossa Iliac ala Arcuate line Acetabulum True pelvis
False pelvis
Acetabulum

3. Male and female pelvis

4. Differences Angle of pubic arch – female wider
Pelvic inlet – female larger
Sacrum – female less curved
Obturator foramen – female oval, male round
Iliac ala – female wider and shallower

5. figure

6. Iliac crest Thicker posteriorly
Highest point palpated posteriorly is at level of L4
Lips of iliac crest
Internal lip
Intermediate lip
External lip

7. L4 is colored

8. Attachments to lips Internal lip Intermediate lip
Anterior lip - Transversus abdominis muscle
Middle lip - Quadratus lumborum muscle
Posterior lip - Sacrospinalis muscle (erector spinae muscles of back)
Intermediate lip
Anterior lip – internal abdominal oblique muscle

9. External lip Anterior lip – external abdominal oblique muscle
Anterior lip – origin of tensor fascia latae muscle
Posterior lip – origin of latissimus dorsi muscle
Whole lip – fascia lata (deep fascia of the thigh)

11. Other Structures on Iliac Crest
Anterior Superior Iliac Spine (ASIS)
Sartorius muscle
Tensor fascia latae
Posterior Superior Iliac Spine (PSIS)
Skin dimples on back
Level of S2 vertebrae

12. Other Structures on the Ilium
Anterior Inferior Iliac Spine
Origin of part of rectus femoris muscle
Attachment for iliofemoral ligament
Posterior Inferior Iliac Spine
Posterior part of the surface that articulates with the sacrum

13. Greater Sciatic Notch Posterior part of ilium
Just inferior to the PIIS
Next slide – structures that pass through the greater sciatic notch

14. Note structures which are above and below the piriformis muscle
Superior gluteal nerve and vessels
Piriformis muscle
Inferior gluteal nerve and vessels
Sciatic nerve
Nerve to superior gemellus and obturator internus muscles
Nerve to inferior gemellus and quadratus femoris muscles
Pudendal nerve and vessels
Posterior femoral cutaneous nerve
Note structures which are above and below the piriformis muscle

15. Post hip fig

16. Post hip2

17. Structures on the external surface of the ilium
Three gluteal lines
Posterior Gluteal line
Anterior Gluteal line
Inferior Gluteal line
Rough area above acetabulum
Origin of reflected head of the rectus femoris muscle

18. Gluteal lines on ADAM Origins of: Gluteus maximus Gluteus medius
Gluteus minimus

19. The ISCHIUM Body of the ischium Acetabulum
External surface is the articular and non-articular surface of the acetabulum
Acetabulum
Articular surface – lunate surface which articulates with the head of the femur
Non-articular surface – acetabular fossa

20. Internal surface of ischium
Forms part of the wall of the true pelvis

21. Structures on posterior border of ischium
Ischial spine
Separates the greater and the lesser sciatic notches
Origin of superior gemellus muscle
Attachment site for the sacrospinous ligament
Ligament helps convert the greater sciatic notch into the greater sciatic foramen
Part of sacroischial joint

22. Post hip lig

23. Lesser Sciatic notch Passageway for: Obturator internus muscle
Nerve to obturator internus muscle
Pudendal nerve and vessles
Note these also travel through the greater sciatic notch

24. Ischial tuberosity Attachment of hamstring muscles
Long head of the biceps femoris muscle
Semitendinosus muscle
Semimembranosus muscle
Origin of Inferior Gemellus muscle
Attachment of sacrotuberous ligament
Part of sacroischial joint
Helps convert both the greater and lesser sciatic notches into foramen

25. Superior ischial ramus
External or lateral wall
Origin of quadratus femoris muscle
On ridge between the superior ischial ramus and the ischial tuberosity
Lower part is part of the origin of the obturator externus muscle

26. The PUBIS Body of the pubis External surface - acetabulum
Articular surface
Non-articular surface – acetabular fossa
Internal surface
Forms part of wall of true pelvis

27. Superior Ramus of the Pubis
External surface
Origin of adductor longus muscle
Just below pubic crest
Internal surface – part of wall of true pelvis

28. Superior border of superior ramus (medial part)
Pubic crest – RA and pyramidalis
Pubic tubercle – inguinal ligament
Medial border – articular surface for attachment of fibrocartilage of pubic symphysis
Lateral part – part of edge of obturator foramen

29. Superior border of superior ramus (lateral part)
Pectineal line – origin of pectineus muscle
Iliopubic eminence
Junction of iliac and pubic bones
Insertion of psoas minor muscle

30. Inferior surface of superior pubic ramus
Obturator crest – part of margin of obturator foramen
Obturator “groove” – passageway for obturator nerve and vessels as they pass through the obturator foramen
Posterior surface – part of origin of obturator internus muscle

31. Inferior pubic ramus External surface Origin of adductor brevis muscle
Origin of gracilis muscle
Origin of adductor magnus muscle (lateral)
Origin of obturator externus muscle (bone near foramen)

32. Structures common to more than one part of the innominate bone
Acetabulum
Obturator foramen

33. Acetabulum Lateral innominate bone Surfaces
Lunate surface – articulating with head of femur
Non-articulating surface – acetabular fossa
Contains a fat pad
Acetabular notch – gap in wall of acetabulum
Attachment of ligamentum teres (ligament of the head of the femur)
Transverse ligament attaches to the edges of the notch and completes the articular surface

34. Obturator foramen Covered by obturator membrane
Origin of obturator internus – from inner (posterior) surface of the membrane and the surrounding bone
Origin of obturator externus – from the external (anterior) surface of the membrane and the surrounding bone
Passageway through the membrane for obturator nerve and vessels to the medial thigh

35. Passages
Structures that enter the lower extremity must travel through the pelvis
There are several different ways that structures (nerves, blood vessels, lymph vessels, muscles and tendons) can travel through or around the pelvis

36. Greater Sciatic Notch Lesser Sciatic Notch Many structures
Sciatic nerve
Superior and inferior gluteal nerves and vessels
Piriformis muscle
Lesser Sciatic Notch
Pudendal nerve and vessels travels back through
Obturator internus muscle and its nerve

37. Obturator foramen
Obturator nerve and vessels through an opening in the obturator membrane at the obturator groove

38. Structures which pass over the pelvic brim to lower extremity
Tendon of the iliacus muscle
Tendon of the psoas major muscle
Femoral Nerve, Artery and Vein
Lateral femoral cutaneous nerve
Lymph vessels

39. Femoral triangle fig

40. Post hip lig

41. Post hip2

42. Quiz on bony landmarks