2. Dr. Nimir Dr. Safaa Ahmed Dr Rania Gabr

3. Objectives Name the structures of the pelvic wall (hip, sacrum, muscles and fascia). Identify the general features of the hip and sacrum. Compare between the male and female hip & sacrum. Recognize the name, type, ligaments & articular surfaces of joints between them. Describe the anatomy of the pelvic cavity (inlet, outlet, content). Discuss the general organization of the pelvic organs in male & female. Describe the peritoneal relations of the pelvic organs.

4. Bony Pelvis The bony pelvis is composed of four bones:  Two “Hip bones” Form the lateral and anterior walls  Sacrum and the coccyx Form the posterior wall

5. Hip Bone The hip bone(innominate bone) is formed of three parts: Ilium Ischium Pubis - They are joined together at the acetabulum - The two hip bones articulate with each other anteriorly at the symphysis pubis and posteriorly with the sacrum at the sacroiliac joints.

6. Inferior to the “acetabulum” is the large obturator foramen The posterior margin of the bone is marked by two notches separated by the ischial spine: - Greater sciatic notch - Lesser sciatic notch.

7. Ilium It is the upper flattened part.It has: - Iliac crest - Anterior iliac spines(superior & inferior) - Posterior iliac spines(superior & inferior. On the inner surface:  Auricular surface(articulates with sacrum)  Iliopectineal line

8. Ischium It has a\an: Body Ischial spine Ischial tuberosity Ischial ramus Pubis It has a\an: Body which has pubic crest & pubic tubercle Superior and inferior rami

9. Sacrum It consists of five rudimentary vertebrae fused together It articulates : - Above with the 5 th lumbar vertebra - Below with the coccyx. - Laterally, the sacrum articulates with the two iliac bones to form the sacroiliac joints.

10. It has the: Sacral promontory is a forward bulge of S1 vertebra. Ala lie on both sides of the sacra promontory Sacral canal. Sacral hiatus is formed by the failure of fusion of the laminae of the S5 vertebra, and sometimes S4 The anterior and posterior sacral foramina are for sacral nerves respectively

12. The pelvis is divided into two parts by the pelvic brim. Above the brim is the false pelvis, which forms part of the abdominal cavity. Below the brim is the true pelvis.

13. It supports the abdominal contents (ileum and sigmoid colon) and after the third month of pregnancy helps support the gravid uterus Also Known as Greater or Major pelvis It is bounded by : - Posteriorly: lumbar vertebrae - Laterally: the iliac fossae and the iliacus muscles - Anteriorly: lower part of the anterior abdominal wall. False pelvis

14. Pelvic Intlet

15. Location of pelvic viscera: the urinary bladder and reproductive organs such as the uterus and ovaries. Also known as Lesser or Minor Pelvis Bounded by the pelvic surfaces of the hip bones, sacrum, and coccyx Limited inferiorly by the musculofascial pelvic diaphragm It has an inlet, an outlet, and a cavity. True Pelvis

16. Pelvic Inlet and Outlet  The pelvic inlet or brim is bounded: Anteriorly: Symphysis pubis, Laterally: Iliopectineal lines Posteriorly: Sacral promontory.

17.  The pelvic outlet is bounded: Anteriorly: pubic arch Laterally: ischial tuberosities Posteriorly: Coccyx - The sacrotuberous ligaments also form part of the margin of the outlet.

18. Pelvic Outlet

19. The pelvic cavity  The pelvic cavity is the space between the inlet and the outlet. It is a short, curved canal, with a shallow anterior wall and a much deeper posterior wall.

20. Pelvic Diameters

21. Difference Between Male & Female Bony Pelvis Bony Pelvis Male Female

22. Difference Between Male & Female Bony Pelvis

24. Female Pelvis

25. Male Pelvis

26. Types of female Pelvis

27. The gynecoid type : Typical female pelvis. The android type: Is the male or funnel-shaped pelvis with a contracted outlet. The anthropoid type: Is long, narrow, and oval shaped. The platypelloid type: Is a wide pelvis flattened at the brim, with the promontory of the sacrum pushed forward.

28. notes The gynecoid type, present in about 41% of women, is the typical female pelvis, which was previously described. The android type, present in about 33% of white females and 16% of black females, is the male or funnel-shaped pelvis with a contracted outlet. The anthropoid type, present in about 24% of white females and 41% of black females, is long, narrow, and oval shaped. The platypelloid type, present in only about 2% of women, is a wide pelvis flattened at the brim, with the promontory of the sacrum pushed forward.

29. The lumbosacral joints are formed between vertebra L5 and the sacrum and consist of: Two zygapophysial joints are between the inferior and superior articular processes Intervertebral disc that joins the bodies of vertebrae LV and SI The lumbosacral joints are reinforced by: Iliolumbar ligament lumbosacral ligament Lumbosacral joints

30. They are synovial joints Each sacro-iliac joint is stabilized by the following ligaments: Anterior sacro-iliac ligament Interosseous sacro-iliac ligament(strongest) Posterior sacro-iliac ligament, Sacrotuberous and Sacrospinous ligaments Pubic Symphsis It is a secondary cartilaginous joint Sacro-iliac joints

32. Anatomical Position of Pelvis

33. Peritoneum in Pelvis Continuous with peritoneum of abdomen It is formed of two layers: 1-Parietal 2-Visceral The parietal peritoneum lines the pelvic walls and is reflected onto the pelvic viscera and becomes continuous with the visceral peritoneum Drapes over pelvic viscera in the midline to form: 1-Pouches In the female the “Rectouterine pouch” is called Pouch of Douglas 2-Folds between viscera and pelvic walls

34. Peritoneum in male

36. Peritoneum in Female

38. Thank you