Download The hand

The hand
The hand consists of the 3 groups:
Proximal part: carpals bones (8)
Middle part: metacarpal bones (5)
Distal part: fingers or phalanges bones (3 for each finger
except for the thumb just 2 bones).
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(irregular bones) divided into two rows:
Proximal which articulates with lower end of foramen ( radial
and ulna) consist of :
Scaphoid (navicular) / lunate / triquetrum / pisiform
** More to medial aspect rather than lateral aspect
Distal part consist of:
Hamate / capitate / trapezoid / trapezium
** More bigger and linear
Laterally, below the distal part of the Radius.
The most fractured bone in the hand because only fall with
your hand extended will hurt the scaphoid bone.
Scaphoid can be repaired by itself because the fusion of the
bone at this level very fast.
Proximal part of scaphoid more protected than distal part but
the middle is more capable to fractured and smaller like neck
with two heads
It bears the whole weight of the body and it is not protected
laterally so when you fall down mostly you will fall on the
lateral aspect of the hand.
Sometimes the radial nerve is injured, leading to thumb and
index paralysis and the opposing movement of the hand will be
stopped.
Untreated scaphoid fractures often do not heal, which can
eventually lead to wrist arthritis.
o notes:
the bigger part of the hand is more toward the lateral aspect
The group of muscles on the lateral aspect (thenar) is bigger
than in the medial aspect (hypothenar).
Located more distal and anterior together with Trapezoid,
anterior to scaphoid
Trapezium rarely to be fractured.
Has two articulate surfaces one for ring finger and the other
for little finger.
It is more or less square in shape.
It is protected by 4th and 5th metacarpals
Can't be seen from posterior aspect only we can see small part
which is in the medial aspect.
Located on medial aspect on top of the Triquetrum.
At the midline
it is elongated but it is smaller in compare with scaphoid
it is protected by trapezium and hamate
articulates with ulna.
has no articulate it will ligate hamate together with lunate
it is protected from fracture because there is no weight bear on
medial aspect and it covered by hypothenar muscle
located between proximal end of phalanges and the distal end
of carpals
We have five metacarpals count them from the thumb (lateral)
to the little finger (medial).
They are long bones; each one consists of a proximal Base,
intermediate shaft {Body} and distal head.
The articulations between metacarpals and the second row of
carpals are occupied by carpometacarpal joint:
1) Little finger and ring finger share one articulation with each
other which is the hamate
2) The thumb will articulate with trapezium
3) The index will articulate with trapezoid
4) The middle will articulate with capitate
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Are made of long bones.
Articulate with each other by interphalangeal joint.
each part ( proximal , middle and distal) consider as long bone
Each phalange consists of three long bones except the thumb
that contains only two long bones (proximal and distal but
others have middle).
They are 14 in number, numbered like the metacarpal from
the lateral to the medial aspect.
Each phalanx consists of: proximal base, intermediate shaft
and distal head.
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Pelvic girdle is bigger when we compare it with the shoulder
girdle
It has to bear weight of human being.
It consists of three fused bones and three fused bones.
The pelvic articulates with the axial skeleton by the sacrum.
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Sacrum
Located in the middle and articulates with two iliac bones.
In the lateral aspect of hip there is:
Upper flat area.
The ilium is a large flaring bone that forms the superior
region of the coccyx bone.
It consists of a body and a superior wing-like portion called
the ala.
The broad posterolateral surface is called the gluteal surface.
The ilium in the posterior aspect has an ear-shaped part and
that's the auricular surface that articulates with the ala of the
sacrum laterally.
Major markings include the iliac crests, four spines, greater
sciatic notch, iliac fossa, arcuate line, and the pelvic brim.
The ilium is limited superiorly by the crest that we can palpate
it from the anterior to the posterior.
The iliac crest has two ends one anterior called the anterior
superior iliac spine and one posterior called posterior superior
iliac spine so the crest extended from the anterior superior
iliac spine to the posterior superior iliac spine, under it there
are anterior inferior iliac spine and posterior inferior iliac
spine but they are not parts of crest.
Note:
***anterior superior iliac spine allows the insertion of external
and internal oblique muscles which make the anterior
abdominal wall, these muscles come from lumbar fascia but
superiorly they take origin from the ribs which are floating
and 8th, 9th and 10th ribs and if you go anterior these muscles,
they fuse together with aponeuroses and these aponeuroses are
thin.
The crest is thicker anteriorly compared with posteriorly.
There is a split border that has two margin one medial and
one lateral but the most aspect of it is the present of iliac
tubercle.
In the lateral view of iliac there are two lines:1. Anterior superior gluteal line
2. Ant. Inf. gluteal line
And these lines provide the origin of the middle and small
gluteus muscles within the buttock region
There is a depression occurs where the ilium meets the ischial
body and this depression is called the greater sciatic notch (it
is inf. to the post. inf. iliac spine and sup. to ischial body.
The ala of the iliac is on the lateral surface.
In the medial aspect there is a roughed area that is called iliac
tubercle and posterior to it there is a fossa called iliac fossa.
In the aspect of the iliac crest, we have the internal lip and the
external lip. And these two lips are important for the
insertion of the muscles.
There are: Inferior gluteal line, anterior gluteal line, the
posterior gluteal line. The posterior one is for what we call it
the gluteus Maximus. The superior and the inferior are for
the minimus, and the anterior is for the Medias.
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An irregular area that has a U-shape.
The ischium forms the posteroinferior part of the hip bone
Participates in forming one third of acetabulum fossa.
The thick body articulates with the ilium, and the thinner
ramus articulates with the pubis
Major markings include the ischial spine, lesser sciatic notch,
and the ischial tuberosity.
The body of ischium contains an ischial tuberosity which is the
part where human being sits on it.
Inf.to the ischial spine in the posterior boarder of the ischium
there is a depression called lesser sciatic notch
Inf. to the lesser sciatic notch there is a greater tuberosity
(huge and irregular shape) widening anteriorly and medially
and this give the ramus (small continuation of the body) that
articulate with inferior ramus of pubic bone
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V-shape.
The pubis forms the anterior portion of the hip bone
It articulates with the ischium and the ilium
Major markings include superior and inferior rami, the pubic
crest, pubic tubercle, public arch, pubic symphysis, and
obturator foramen (along with ilium and ischium).
The two bones of pubic fused together at pubic crest to form
pubic symphysis.
The pubis symphysis is wide anterior bone that comes closed
by adhesion fused between both pubic crests in a cartilaginous
ligament (so it is less movable than any other joint compared
with synovial joint).
In the superior aspect of the crest there are pubic tubercle,
inferior ramus as well as superior ramus.
The superior border of the inferior ramus of the pubis form an
opening and that's what we call it the inlet of the pelvis or the
pelvic brim.
The pectineal line of the pubis: is a ridge on the superior
ramus of the pubic bone, forms part of pelvic prime and in
combination with the arcuate line it makes the iliopectineal
line.
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These bones will fuse and they will meet in a big depression
called acetabulum.
From the lateral aspect within the acetabulum there is a
depression called the acetabular fossa.
The acetabulum is not rounded completely.
The articular process (surface) of the acetabulum has lunate
surface that articulates with the head of the femur.
In anatomical position of the pelvic, the hip opening is oriented
anterior not superior (the post. Sup. Iliac spin is on the same
line with ischial tuberosity and ant. Sup. Iliac spine is on the
same line with pubic symphysis).
Notes:
**Acetabular fossa is non-articular space with the head of the
femur, it fixed in their ligamentum fovea. Ligamentum fovea comes
from the fovea capitis of the femur head. This fovea capitis is the site
into which the blood vessels enter into the head of the femur. So any
movement or any cutting in that fovea capitis or the foveal ligament
might put this part of bone in danger because of lack of
vascularization.
**the acetabular notch is completed by the presence of interacetabulum ligament that prevents the head of femur from
dislocation downward.
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an opening (usually closed by an obturator
membrane that contains an opening called obturator canal where
the obturator nerve pass).
Formed by :
The inferior and superior ramus of pubis.
Horizontal part of pubis.
The body of pubis.
The ischium bone.
Arcuate line from auricular surface of iliac to the pubic tubercle.
The arcuate line divides the pelvic into two regions: one is called
false pelvic and the other is called true pelvic.
The small intestine and part of large intestine located in the false
pelvic while the reproductive and parts of urinary system located
in the true pelvic.
The pelvic brim will allow us together with the iliopectineal line
to differentiate between abdominal (false pelvis) region and the
(true pelvis) region, one belong to the abdomen and one belong to
the pelvis.
*The angle pubic arch over here is smaller if you compare with the
female which is bigger.
*The shape of the pelvis is more heart shaped in women.
*It's wider in female laterally if you compare it with the narrow and
deep pelvic cavity in the male.
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1. Illiosacral joint
2. Muscles that come from posterior aspect of abdomen and
they go to the anterior aspect of the thigh.
3. Muscles that locate in gluteal region and these muscles go
down away in the posterior aspect of the thigh.
4. Two ligaments that run from
** From the Sacral into the iliac (which the anterior
sacroiliac ligament and the posterior sacroiliac ligament
that comes from the sacrum into the auricular surface of
the ilium)
**from the Sacral into the ischium:
A. From the Sacral into the ischial spine = (sacrospinal
ligament) >>> smaller and more anterior >>>creates
greater sciatic foramen
B. From the Sacral into the ischial tuberosity =
(sacrotuberous ligament)>>>creates lesser sciatic
foramen.
And these ligaments have two important functions:
 To hold the pelvic girdle to the axial skeleton.
 To provide an openings within the posterior cavity and we call
it pelvic outlet.
5. Iliolumbar ligament and that comes from the transverse process
of the lumbar number 5 into the superior posterior border of the
iliac crest.
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The sole bone of the thigh is the femur, the largest and
strongest bone in the body.
It articulates proximally with the hip and distally with the
tibia and fibula.
Major markings include the head, fovea capitis, greater and
lesser trochanters, gluteal tuberosity, lateral and medial
condyles and epicondyles, linea aspera, patellar surface, and
the intercondylar notch.
Note: The neck , if you look at the neck of humerus and
compare it with the neck of femur , you will see that the neck
–anatomical neck- especially of the humerus , if you compare
it with the anatomical neck of the femur (there is no surgical
neck in femur ) you will see that's very small , and this is long
,and in reality it's longer than that ,that's why it has lot of
vascularization and that's lateral circumflex artery and
medial circumflex artery that comes from the femoral artery .
they will irrigate most the head of the femur together with
these protrusions , and practically , they will concentrate into
the neck
Fovea capitis: is a depression on the head of the femur, it is
the entrance of the obturator artery branch that irrigate the
whole articular surfaces together with acetabular fossa and
the head of the femur as well.
The head of the femur practically will receive vascularization
from the femoral artery as well from the obturator artery.
That's necrosis of the head and the neck occurs only if these
arteries have been blocked.
The head is more rounded, is almost a ball shape, it's not
complete.
The neck is long.
the trochanters , which are :
1 – Lesser trochanter, is located medially
2- Greater trochanter, is located laterally
The inter-trochanteric line, is the line that connects the two
lesser and greater trochanter from the anterior aspect.
If you go down, the shape of this bone is triangular with :
anterior , medial , and lateral surfaces .
The patellar surface of the lateral aspect: the surface which is
an articular surface and it is very smooth area of the lower
extremity of the anterior aspect of the femur.
Epicondyles: medial and lateral. Those are very important
for the origin of the muscles that goes down into the leg.
Adductor tubercle: is located superior to medial epicondyles
and it's an elevation for the (adductor Magnus muscle) which
leaves a gap; and that's what we call it: the adductor canal.
Posterior surface practically, we have a crest, which is
sharper, that connects the two greater and lesser trochanters,
the neck, the head, and the fovea capitis.
Linea aspira: a very sharp line in the posterior surface of the
femur.
The linea aspira: practically divide inferiorly into medial and
lateral supracondylar lines that go and end up with the
lateral and medial condyles.
condyles :In the lower extremity which is the posterior aspect
, you see two condyles ; medial and lateral condyles .Those
are smooth surfaces that articulate with the condyle of the
tibia that are residing in a superior aspect of the upper
extremity of the tibia , between them we have intercondylar
fossa.
The patella is a sesamoid bone that practically has two facet;
each one is for each condyle of the femur, one for the medial
and on for the lateral condyles.
Surface for the patella: the anterior aspect is more roughened
than the posterior aspect.
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The tibia and the fibula practically are two bones that are
forming the leg.
The upper extremity of the tibia is very important because it
articulates with the condyle, presenting two condyles lateral
and medial surfaces condylar surface, and it has intercondylar eminence which is a protrusion that goes into the
inter-condylar fossa.
Tibial tuberosity: This can be palpable in the anterior aspect
of the tibia.
The lower edge of the tibia is called “medial malleolus”.
Lateral malleolus is made by the whole extremity of the
fibula also provides fibular notch.
The fibula superiorly, has head and neck and it's long shaft,
in comparing with the tibia; it's a very small in diameter.
The interosseous membrane again exists between the two
bones, and we have an opening which is for the anterior
tibial artery and nerve.
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Bones of the foot are tarsals, metatarsals, and phalanges.
 Calcaneus is the biggest that form the heel; above the
calcaneus we have talus.
 We have facet for lateral malleolus and facet for the medial
malleolus.
 The medial and lateral malleolus of the lower extremity of the
leg articulate with the (TALUS), they have nothing to do with
calcaneus.
 The navicular, the intermediate cuneiform, medial cuneiform,
lateral cuneiform, and those are form tarsal bones together
with calcaneus and talus.
 And then we have the metatarsals and phalanges
 the arches of the foot, there are three arches of the foot:
1-lateral longitudinal
2-medial longitudinal
3-transverse.
***Notes: *That's the fracture of the femur in the neck and
below the intertrochanteric crest>>> slide 34
*And the is the patella you can see it, this is part of lower leg
fracture >>>slides (35-36)
*Slides from18-40 the dr checked them fast, so try to see
them.
Types of fractures:
The end …
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