Download Pelvis Pavel ŠNAJDR

Bones, ligament, joints of the
lower limb
Pelvis
Pavel ŠNAJDR
ilium
ischium
pubis
Pelvis – 3+1 bones
hip bone with sacrum -SI joint
two hip bones - symphysis
true (or lesser) pelvis –bony canal through
which the child passes during birth
.
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.
symphysis pubis
-cartilagineous interpubic disk with small
nonsynovial cavity
superior and inferior pubic ligament
obturator membrane -obturator canal
for obturator blood vessels and nerve
suprapiriform
foramen
s.g.v. and n.
infrapiriform
foramen
i.g.v. and n.
i.p.v. and p.n.
s.n. , p.f.c.n.
Sex differences of the pelvis
female: wider, transversely directed obturator
foramina, pubic arch
lesser pelvis is larger than in male
male: longitudinally orientated obturator
foramina, subpubic angle
subpubic angle
x pubic arch
True pelvis
4 planes,
baby´s head
has to descend
during birth
The biggest
diameter of the
newborn´s
head fits into
the biggest
diameter of
each plane
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/
inlet
angustia
outlet
true (obstetric) conjugate – from retropubic eminence to promontory 10,5 cm
diagonal conjugate – lower edge of symphysis to promontory –13cm
external pelvic meauserments:
interspinous distance – 26 cm
intercristal distance – 29 cm
intertrochanteric distance – 31 cm
external conjugate (Badelocque) – upper edge of symphysis to spinous
process of L5, 18-20 cm
angle of inclination 125-130
coxa valga
coxa vara
hip joint
knee joint
prox. and dist. tibiofibular joint
talocrural (ankle) joint
subtalar + talocalcaneonavicular
calcaneocuboid
tarsometatarsal joint
metatarsophalangeal joint
interphalangeal joint
Hip joint
ball and socket joint
femoral head–lunate 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
Movements
flexion/extension
abduction/adduction
rotation
circumduction
cemented
non-cemented prosthesis
Knee joint
complex joint: femorotibial +femoropatellar
femoral condyles – tibial condyles
incongruence of their surfaces is compensated by
menisci med. + lat.
patellar surface of F -articular surface of P
Ligaments 1
patellar lig.
med. + lat. patellar retinaculum
tibial collateral lig.
fibular collateral lig.
oblique popliteal lig.
arcuate politeal lig.
Ligaments 2
anterior cruciate lig.
posterior cruciate lig.
transverse lig. of the knee
ant. + post. meniscofemoral lig.
infrapatellar fat pad
synovial and fibrous layer of capsule are separated
- cruciate ligg are intracapsular but extra-articularly
synovial bursae
movements
flexion/extension combined with rotation
gliding 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
arthroscopy
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.
Ankle (talocrural) joint
trochlea(pulley) of T - malleolar mortise
(deep socket)
medial = deltoid lig.(4 parts)
lateral lig. (3 parts)
movement: plant.flexion/dors. flexion
Deltoid (medial) ligament
- tibionavicular part
- ant. tibiotalar part
- tibiocalcaneari part
- post. tibiotalar part
Lateral ligament
- ant. talofibular ligament
-post. talofibular lig.
-calcaneofibular lig.
.
subtalar joint (post.articular
facets of T and C)
talocalcaneonavicular
calcaneocuboid
form functional complex
allowing
eversion/inversion of foot
Chopart´s joint line = transverse tarsal joint
complex of C-C and T-N joint
bifurcate lig. (calcaneonavicular + calcaneocuboid)
Lisfranc´s joint line - complex of
tarsometatarsals and intermetatarsals joints
MTT2 projects proximally !
Great number of short ligg. connecting leg bones to
tarsals, connecting tarsals between themselves,
connecting tarsals and metatarsals
plantar aponeurosis, long plantar lig., plantar
calcaneonavicular (spring) lig., short plantar ligg.
Foot (plantar) arches
tarsal and MTT bones are arranged in longitudinal
(med. , lat.) and transverse arches with shock absorbing,
weight bearing function
are maintained by:
1. Shape of interlocking bones
2. Strength of the plantar ligg. + plantar aponeurosis
3. Action of tendons of muscles – tibialis ant. and
post., peroneus longus and btrevis, flexors of the foot