1. Pelvis: structure, diameters, static

2. os coxae (pelvic bone) 2x!
Osseous pelvis
Sacroiliac joint
sacrum
os coxae (pelvic bone) 2x!
coccyx (tail bone)
Ring, composed of 3 (+1) bones
Limited movements, great forces and shear stress
Coccyx has no major mechanical role
Pubic symphysis

3. Os coxae
os ileum
os pubis
os ischium

4. 3 bones ossify together near puberty to form an 8-shaped structure
Firs centers of ossifications already visible at 3rd fetal month
Common body of the bones forms the acetabulum – extremely strong
Force acting from proper direction in utero is inevitable for the normal development of acetabulum.
(hip dysplasia)
pecten
Symphyseal surface

5. Hip dysplasia, hip dislocation
Causes: intrauterine developmental defect of acetabular fossa, not deep enough, can dislocate to relatively small forces.
(twins, oligohydramnion, ??)
Screening (physical examination, ultrasound)

6. Hip dysplasia, hip dislocation
Therapy: proper positioning of femur after birth:
Pavlik harness
(anteflexion, abduction)
Forces acting on the head of femur deppen the acetabular fossa!
Operations rarely needed today.
Greater degrees in small children!

7. Sacrum, coccyx
5 sacral and 2-4 coccygeal vertebrae ossify together (synostosis).
Coccyx fairly rudimental, can ossify together with sacrum.
Problems at birth.
Auricular surface
(fibrous cartilage)

8. Sacroiliac joint, pubic symphysis
Structures holding osseous ring together:
Sacroiliac joint (plane joint)
great shear stress: fibrous cartilage
symphysis (synchondrosis – almost proper joint)
Sacroiliac joint
Pubic symphysis

9. Pubic symphisis

10. Bones and ligaments Greater schiatic foramen Obturator canal
Sacrospinous lig.
Sacrotuberous lig.
Inguinal lig.
Lesser schiatic foramen
Obturator membrane (+ m. obt. Ext, int.)

11. A sacralis izületi porc (csíkozott)
helyzetváltozása fekvő és álló testhelyzetben
Laid position standing position

12. Anterior sacroiliac ligaments

14. Ligaments of Sacroiliac joint
Sacro-iliac ligaments dorsal
inerosseal
ventral
Functionally belong to here:
Ileolumbal lig. ,
Sacrospinous lig.
Sacrotuberous lig.
(two-armed lever)

15. Static of pelvis: center of gravity
Passing through the following structures:
atlantooccipital joint
lower lumbar vertebrae, anterior to promontory
head of femur - acetabulum
talus (highest point of longitudinal lantar arch)
Weight and support in the same plane! – Can stay in equilibrium without continuous muscle work.
It is only possible if the superior aperture of pelvis is bent degrees! – Pelvic inclination
Anterior superior iliac spine and symphisis in the same vertical plane

16. Pelvic inclination Approximately 60-65 degree.
(male – 60, female – 65)
Ant. Sup iliac Spine and symphysis lies approximately in the same frontal plane.
Position of sacrum: almost horizontal.

17. Leonardo da Vinci
Vesalius (1538)

18. Importance of the center of gravity: scoliosis
One convex curve is always compensated by another in the opposite direction.

20. Flexible support, energy absorption
Two-armed lever
F1 x d1 = F2 x d2 F1 F2 d1 d2
Flexible support, energy absorption

22. Álló testhelyzetben a vertikalis nyomóerő a sacrumot a medencébe nyomja (max. 2mm-t)
Gátló szalagai: Ligg. sacroiliaca
FELSŐ TESTFÉL NYOMÁSA
Sacrum nem „zárókő”
SACRUM LE-SÜLLYED
A symphysisre ható húzóerőket a lig. pubicum superius gátolja

23. Double arch

24. Aqueduct, Pont du Gard, Franciaország

25. Sitting position Force/weight is transferred to tuber ischiadicum.
„Sitting tubercule”!
Sacrum is vertical
No inclination

26. Pelvis minor Superior aperture : 60-65º - inclinatio pelvis
Terminal line (linea terminalis):
Promontory
Lateral mass
Arcuate line
Pecten ossis pubis
Symphysis, upper border
Inferior aperture:
10-15º
Coccyx
Sacrotuberous lig.
Rami of pubic and schiaticbones Symphysis, inf. border

27. Diameters of the lesser pelvis
a: superior aperture
b: cavity (amplitudo pelvis)
(greatest diameter)
c: angustia pelvis
(smallest diameter)
d: inferior aperture a b
HOUR-GLASS FORM c d

28. distantia spinarum (25-26 cm) distantia cristarum (28-29 cm)
Diameters: superior aperture
Greatest: transverse diameter
Median diameter
11 cm
Oblique diameter
12 cm
Transverse diameter
13 cm
distantia spinarum (25-26 cm)
distantia cristarum (28-29 cm)

29. Conjugates a b c a: conjugata anatomica vera
anatomical conjugate 12 cm
b: conjugata anatomica obstetrica
obstetric conjugate
11.5 cm
c: conjugata diagonalis
diagonal conjugate
13 cm
Diagonal conjugate can be measured by intravaginal examination. a b c

30. Diameters: amplitudo pelvis
Almost circular
Greatest diameter: oblique (approx.14 cm)
All diameters >13cm

31. Diameters: angustia pelvis
Almost circular
Smallest diameters of pelvis
Greatest diameter: oblique (approx.10 cm)

32. Diameters: inferior aperture
11,5-12 cm
Coccyx bends away: 2 cm

33. Greatest diameters Superior aperture: transverse: 13-13.5 cm
Amplitudo pelvis:
oblique: 14 cm
Inferior aperture:
sagittal: cm

34. A bit of gynecology oblique transverse sagittal
At birth, the head of the baby must always fit to the greatest diameters: rotates 90 degrees!

35. Axis pelvis
Bent tube

36. Normál AP. Rtg.

37. Post-partum pubic diastasis

38. Sexual differences
Arcus pubis
(90-100°)
Angulus pubis
70°
Female
Male

39. Female
Male

40. Intramuscular injection
Triangular technique
(trochanter major, anterior superior iliac spine, iliac crest)
NOT to hit: superior gluteal
a., v., n.
Sobota - Atlas of Human Anatomy

41. Subinguinal hiatus Lacuna musculonervosa: lateral cutaneus femoral n.
m. iliopsoas
femoral n.
Lig. lacunare
Lacuna vasorum:
femoral a., v.
genitofemoral n. (femoral br.)
Lacuna lymphatica (herniosa):
lymph vessels
Inner opening of femoral canal!!
(anulus femoralis)
Sobota - Atlas of Human Anatomy
Femoral canal: septum femorale, l. lymphatica, femoral triangle (iliopectineal fossa), saphenous hiatus
Femoral herniation (especially common in females)

42. Femoral artery in superficial position – risk of injury!!!
Sobota - Atlas of Human Anatomy
Palpatable femoral artery!
First aid!!
Regions supplied by spf. and deep inguinal lymph nodes:
lower extremity, inferior superficial part of abdominal wall, external genital organs (NOT THE TESTIS!!!)
drain further to the pelvic nodes near the. Iliac artery.
Lymph node enlargement is fairly common, mostly caused by banal infection.

43. Obturator canal
Obturator foramen covered by obturator membrane and two muscles, obturator externus and internus.
Only a small canal is left:
obturator canal
It connects the pelvis to the adductor compartment of the thigh.
Contents: obturator artery, vein, nerve
"obturator herniation„ - rare

45. Irodalom
Szentagothai J, Réthelyi M: Funkcionális anatómia, Medicina, 1989
Sobota - Atlas of Human Anatomy, 20th edition, Urban and Schwarzenberger, 1993
Renner Antal: Traumatológia, 2. kiadás, Medicina, Budapest, 2003
Vízkelety Tibor: Az ortopédia tankönyve, 2. kiadás, Semmelweis Kiadó, 1999
A radiológiai felvételek a következő oldalról származnak: