FEMUR 2
(MYOLOGY AND CLINICAL ANATOMY)
OBJECTIVES
By the end of the lecture students should be able to:
Know the attachments of the different muscles and ligaments on the bone
Know the arterial supply of the bone
Get the general idea about fractures of femur and other clinical conditions
LECTURE OULINE
Muscle attachments on femur posteriorly
Muscle attachments on femur anteriorly
LIGAMENTS OF THE NECK
Capsule of the hip joint
The iliofemoral ligament(of Bigelow)
The pubofemoral ligament
The ischiofemoral ligament (only reaches the zona orbicularis)
The ligament of the head, the ligamentum teres.
MUSCLES OF THE NECK
The lower part the neck RECIEVES the tendon of obturator externus.
ATTACHMENTS ON THE GREATER TROCHANTER
The diagonal impression RECIEVES the tendon of the Gluteus medius
The triangular area on lateral surface if smooth holds the bursa between the bone and gluteus medius
if rough receives a part of the muscle
Area below and behind the diagonal impression receives tendon of gluteus maximus
Thetrochanteric fossa(digital fossa) RECIEVES the tendon of the Obturator externus
Above and in front of this the Obturatorinternus and Gemelli are inserted.
Thesuperior borderRECIEVES insertion of the Piriformis
Theinferior bordergives origin to the upper part of the Vastus lateralis
Theanterior border affords insertion at its lateral part to the Gluteus minimus.
ATTACHMENTS ON UPPER END OF FEMUR
ATTACHMENTS ON THE LESSER TROCHANTER
Thesummitof the trochanter gives insertion to the tendon of the Psoas major
Thelinea quadrata,and gives attachment to the Quadratus femoris and a few fibers of the Adductor magnus.
The tubercle of femur is the point of meeting of five muscles: the Gluteus minimus laterally, the Vastus lateralis below, and the tendon of the Obturator internus and two Gemelli above.
The upper half of linea aspera affords attachment to the iliofemoral ligament of the hip-joint and its lower half gives origin to the upper part of the Vastus medialis.
A slight thickening about the middle of the intertrochanteric crest, gives attachment to the upper part of the Quadratus femoris.
iliopsoas
ATTACHMENTS ON THE BODY OF FEMUR
Thegluteal tuberosity gives attachment to part of the Gluteus maximus
Pectineal linegives attachment to the Pectineus
Between the medial ridge and the intertrochanteric line, a portion of the Iliacus is inserted
Theadductor tubercle affords insertion to the tendon of the Adductor magnus.
From themedial lipof the linea aspera, the Vastus medialis arises
From thelateral lip, the Vastus lateralis takes origin.
The Adductor magnus is inserted into the linea aspera
ATTACHMENTS ON THE SHAFT
Attachments on medial surface of Shaft
CONTD…
Between the Vastus lateralis and the Adductor magnus two muscles are attached—the Gluteus maximus above, and the short head of the Biceps femoris below.
Between the Adductor magnus and the Vastus medialis four muscles are inserted: the Iliacus and Pectineus above; the Adductor brevis and Adductor longus below.
From the upper three-fourths of anterior surface the Vastus intermedius arises
From the upper part of it the Articularis genu takes origin.
From the upper three-fourths of lateral surface of the body of femur the Vastus intermedius takes origin.
Medial surface of body is covered by the Vastus medialis.
ATTACHMENTS AT THE LOWER END OF THE FEMUR
Ligaments:
The posterior cruciate ligament of the knee-joint is attached to the lower and front part of the medial wall of the intercondylar fossa
The anterior cruciate ligament attaches to an impression on the upper and back part of lateral wall of the fossa.
Themedial epicondylehas the tibial collateral ligament of the knee-joint is attached to it.
Thelateral epicondyle, gives attachment to the fibular collateral ligament of the knee-joint.
Anterior view
LATERAL VIEW
Muscles at the lower end of femur:
Behind the medial epicondyle is a rough impression which gives origin to the medial head of the Gastrocnemius.
The Popliteus arises from the depression below the lateral condyle
Above and behind the lateral epicondyle is an area for the origin of the lateral head of the Gastrocnemius.
Above and to the medial side of gastrocnemius, the Plantaris arises.
ARTERIAL SUPPLY OF THE FEMUR
Mainly supplied by profunda femoris
Nutrient artery usually enters bone proximally and posteriorly along the linea aspera
Usually it comes of the 2nd perforating artery
The upper end of the femur is supplied by the nutrient artery of the shaft, the retinacular vessels of the capsule, and the foveolar artery of the ligamentum teres.
The retinacular vessels consist of three separate groups: postero-superior, posteroinferior, and anterior.
These vessels are the chief supply to the epiphysis and femoral head at all ages.
The foveolar artery constitutes a small and subsidiary blood supply to the femoral epiphysis
FRACTURES OF THE FEMUR
Types of fractures include the following:
SIMPLE - There is only one fracture line, and the bone is broken into 2 pieces.
COMMINUTED - There is more than one fracture line, and there are more than 2 bone fragments at the fracture site.
CLOSED - The skin in the fracture area is not broken, and the break is not exposed to the outside.
OPEN (COMPOUND) - The skin over the fracture is broken, exposing the broken bone.
PATHOLOGICAL - The bone has been weakened or destroyed by disease so that it breaks easily.
STRESS - There is a hairline crack in a bone, sometimes not even visible on an X-ray, which is caused by repeated injury or stress on the bone
AVASCULAR NECROSIS OF THE HEAD OF FEMUR
The retinacular fibres hold down the arteries to the head (mostly from the trochanteric anastomosis)
Their rupture may result in avascular necrosis of the head of the femur in intracapsular fracture of the neck.
Revacularization of the head depends on new vessels crossing the fracture line, not on any within the ligament of the head
OSTEOARTHRITIS OF HIP JOINT
Effects the hip joint
Extremely painful, limiting activity
A chronic disease and is characterized by destruction of cartilage, overgrowth of bone, bone spur formation and impaired function.
This type of arthritis occurs when bone rubs against bone.
Especially in old age
LEARNING RESOURCES
Gray’s Anatomy by Henry Gray
Last’s Anatomy by R.J.Last
Netter’s Atlas by Frank H. Netter, MD