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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