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FEMUR
ATTACHMENTS AND CLINICAL ANATOMY)
LEARNING 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
MUSCLE ATTACHMENTS ON FEMUR
ANTERIORLY
MUSCLE ATTACHMENTS ON FEMUR
POSTERIORLY
LIGAMENTS OF THE NECK
• Capsule of the hip joint
• The ligament of the head, the ligamentum
teres.
• The iliofemoral ligament (of Bigelow)
• The pubofemoral ligament
• The ischiofemoral ligament (only reaches
the zona orbicularis
MUSCLES OF THE NECK OF FEMUR
• 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
• The trochanteric fossa (digital fossa) RECIEVES the tendon of the
Obturator externus
• Above and in front of this the Obturator internus and Gemelli are inserted.
• The superior border RECIEVES insertion of the Piriformis
• The inferior border gives origin to the upper part of the Vastus lateralis
• The anterior border affords insertion at its lateral part to the Gluteus
minimus.
ATTACHMENTS ON UPPER END OF FEMUR
ATTACHMENTS ON THE LESSER TROCHANTER
• The summit of the trochanter gives insertion to the tendon of the
Psoas major.
• The linea 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.
ATTACHMENTS ON THE BODY OF FEMUR
• The gluteal tuberosity gives attachment to part of the Gluteus maximus.
• Pectineal line gives attachment to the Pectineus.
• Between the medial ridge and the intertrochanteric line, a portion of the
Iliacus is inserted
• The adductor tubercle affords insertion to the tendon of the Adductor
magnus.
• From the medial lip of the linea aspera, the Vastus medialis arises
• From the lateral 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.
• The medial epicondyle has the tibial collateral ligament of the knee-joint
is attached to it.
• The lateral 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.
FRACTURES OF THE FEMUR
• 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.
AVASCULAR NECROSIS OF THE HEAD OF FEMUR
• Revascularization 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
• 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
REFERENCES
• Gray’s Anatomy by Henry Gray
• Last’s Anatomy by R.J.Last
• Netter’s Atlas by Frank H. Netter, MD
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