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Transcript
FEMUR 2:
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
OUTLINE OF ATTACHMENTS ON THE FEMUR:
Posterior view:
Anterior View
ATTACHMENTS ON THE NECK:
MUSCLES:

The lower part the neck alongside the crest is bare bone, over which the
tendon of obturator externus.
LIGAMENTS:

The intertrochanteric line receives the
anterior part of the capsule of the hip joint
and gives attachment of to the iliofemoral
ligament (of Bigelow), whose thickest part is received into the low
tubercle at the lower end of the line

The pubofemoral ligament is attached into the lower surface of the neck
longside capsular attachment

The ischiofemoral ligament only reaches the zona orbicularis

Fovea attaches the ligament of the head, the ligamentum teres.

ATTACHMENTS ON THE GREATER TROCHANTER:

The diagonal impression on the lateral surface serves for the insertion of
the tendon of the Gluteus medius

The triangular area on lateral surface if smooth holds the bursa between
the bone and gluteus medius, and if rough receives a part of the muscle

Area below and behind
the diagonal impression
receives tendon of
gluteus maximus with
intervening bursa

The trochanteric
fossa (digital fossa)
receives the insertion of the tendon of the Obturator externus, and above
and in front of this an impression for the insertion of the
Obsturator internus and Gemelli.

The superior border is marked near the center by an impression for the
insertion of the Piriformis

The inferior border is marked by a rough, prominent, slightly curved
ridge, which gives origin to the upper part of the Vastus lateralis

The anterior border is prominent and somewhat irregular; it affords
insertion at its lateral part to the Gluteus minimus.
Gluteus
maximus and minimus
ATTACHMENTS ON THE LESSER
TROCHANTER
:

The sum
mit of the
trochant
er 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
Glutæus 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:

From the medial lip of the linea
aspera, the Vastus medialis
arises

From the lateral lip, the Vastus
lateralis takes origin.

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.

The Adductor magnus is inserted into the linea aspera, and to its lateral
prolongation above, and its medial prolongation below.

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 kneejoint is
attached to
the lower and front part of the medial wall of the fossa and the anterior
cruciate ligament to an impression on the upper and back part of its
lateral wall.

The medial epicondyle has the tibial collateral ligament of the kneejoint is attached to it.

The lateral epicondyle, gives attachment to the fibular collateral
ligament of the knee-joint.
Muscles:
 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 although
there is variation

nutrient artery usually enters bone proximally
and posteriorly along the linea aspera;

usually there is only one nutrient artery
(maximum of 2);

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
NERVOUS SUPPLY OF THE FEMUR:
CLINICAL ANATOMY RELATED TO FEMUR:
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
Symptoms of a femur fracture include:





severe pain
swelling and bruising
inability to walk
visible deformity at the site of fracture
the feeling that the bone in your thigh is moving
AVASCULAR NECROSIS OF THE HEAD OF FEMUR:

Many vascular foramina, directed towards
the head perforate the upper and anterior
surfaces of the neck; the largest are for
veins, not arteries.

Grooves and ridges on the surface
indicate the attachment of retinacular
fibres, reflected from the attachment of the
hip joint capsule to the articular margin of
the head.

These fibres hold down the arteries to the
head (mostly from the trochanteric
anastomosis) and 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
http://www.medscape.com
http://www.emedicine.com
http://www.pediatric-orthopedics.com
http://www.ncbi.nlm.nih.gov