Bones, ligament, joints of the lower limb

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Bones, ligament, joints of the lower limb

• Pelvis

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Pelvis 31 bones hip bone with sacrum -SI
joint two hip bones - symphysis true (or
lesser) pelvis bony canal through which the
child passes during birth.
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ilium
ischium
pubis
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suprapiriform foramen sup. gluteal vessels and
nn. infrapiriform foramen inf. gluteal vessels
and nn. int. pudendal vessels and pudendal
nerve, sciatic n.
post. femoral cutaneous n.
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Sacroiliac (SI) joint Almost immobile kloub
(amphiarthrosis) Auricular surfaces of both
bones strong capsule sacroiliac lig. (ventr.,
dors., interosseous) iliolumbar lig. connecting
the ilium to the L4,L5 sacrotuberous and
sacrospinous ligg.
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symphysis pubis-cartilagineous interpubic disk
with small nonsynovial cavitysuperior and
inferior pubic ligament obturator membrane
-obturator canal for
obturator blood vessels and nerve
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Sex differences of the pelvisfemale wider,
transversely directed obturator foramina, pubic
arch
lesser pelvis is larger than in malemale
longitudinally orientated obturator foramina,
subpubic angle
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subpubic angle x pubic arch
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True pelvis 4 planes, babys head has to descend
during birth The biggest diameter of the
newborns head fits into the biggest diameter of
each plane
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Pelvic measurements in obsterics (and anatomy)
stright, obligue and transverse diameter
1.pelvic inlet promontory, iliopectineal lines,
symphysis/ tr. dia.13 cm/ 2.pelvic cavity
amplitudo S2-3, acetabulum, center of symhysis/
obl. dia..-13,5 cm/ angustia - spina ischiadica,
sacrum, lower end of symphysis / str. dia. 11,5
cm/ 3. pelvic outlet - 2 triangles pubic
arch, ischial tuberosities, coccyx / str.
dia.11,5 cm/
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inlet
outlet
angustia
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true (obstetric) conjugate from retropubic
eminence to promontory 10,5 cmdiagonal conjugate
lower edge of symphysis to promontory
13cmexternal conjugate (Badelocque) upper
edge of symphysis to spinous process of L5, 18-20
cm
interspinous distance 26 cmintercristal
distance 29 cmintertrochanteric distance 31
cm
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angle of inclination
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coxa valga
abnormal diemeter of angle of inclination results
in abnormal leg posture, usually combined with
(compensated by) abnormal knee position
coxa vara
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hip jointknee jointprox. and dist. tibiofibular
jointtalocrural (ankle) joint subtalar
talocalcaneonavicular calcaneocuboid
tarsometatarsal jointmetatarsophalangeal joint
interphalangeal joint
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Hip jointball and socket joint femoral
headlunate surface of acetabulum additional
features acetabular lip (labrum) transverse
acetabular lig. reinforcing ligg. iliofemoral
lig. pubofemoral lig.
ischiofemoral lig.
zona orbicularis
lig. of the head of F
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Movementsflexion/extensionabduction/adductionr
otationcircumduction
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total hip replacement
cemented and noncemented prosthesis
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Knee jointcomplex joint femorotibial
femoropatellar femoral condyles tibial
condyles incongruence of their surfaces is
compensated by meniscus med. lat. patellar
surface of F -articular surface of P
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Ligaments of knee 1patellar lig.med. lat.
patellar retinaculumtibial collateral
lig.fibular collateral lig.oblique popliteal
lig.arcuate politeal lig.
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Ligaments of knee 2 anterior
cruciate lig. posterior cruciate lig.
transverse lig. of the knee ant.
post. meniscofemoral lig.
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infrapatellar fat pad
synovial and fibrous layer of capsule are
separated - cruciate ligg are intracapsular but
extra-articular
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synovial bursae
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movementsflexion/extension combined with
rotationgliding and rolling movements extended
knee is in locked position (medial rotation of
F)- initial phase of flexion is unlocking
(untwisting) process (lateral rotation of
F)forced abduction/adduction
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arthroscopy
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proximal T-F joint head of F-
fib.art.facet of lat.tib.condyle interosseous
membrane dist. T-F joint tibiofibular
syndesmosis - special kind of connection allowing
minimal movement essential for proper ankle joint
function ant. post. tibiofibular ligg.
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Ankle (talocrural) jointtrochlea(pulley) of T
- malleolar mortise(deep socket)medial
deltoid lig.(4 parts) lateral lig. (3 parts)
movement plant. flexion/dors. flexion
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Deltoid (medial) ligament- tibionavicular part-
ant. tibiotalar part - tibiocalcaneari part -
post. tibiotalar partLateral ligament- ant.
talofibular ligament-post. talofibular lig.
-calcaneofibular lig.
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subtalar joint (post.articular facets of T and C)
talocalcaneonavicular calcaneocuboid form
functional complex allowing eversion/inversion
of foot
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Choparts joint line transverse tarsal joint
complex of C-C and T-N jointbifurcate lig.
(calcaneonavicular calcaneocuboid) Lisfrancs
joint line - complex of tarsometatarsals and
intermetatarsals jointsMTT2 projects proximally
!Great number of short ligg. connecting leg
bones to tarsals, connecting tarsals between
themselves, connecting tarsals and metatarsals
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plantar aponeurosis, long plantar lig., plantar
calcaneonavicular (spring) lig., short plantar
ligg.
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Foot (plantar) arches
tarsal and MTT bones are arranged in longitudinal
(med. , lat.) and transverse arches with shock
absorbing, weight bearing function
are maintained by1. Shape of interlocking
bones2. Strength of the plantar ligg. plantar
aponeurosis3. Action of tendons of muscles
tibialis ant. and post., peroneus longus and
btrevis, flexors of the foot