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The Skeleton 1 M ATERI ALS Anatomage Dissecting Table • human skeleton • vertebrae and bones • flexible spine model • human skull • textbook and class notes for reference • various wall models O BJECTIVES Upon the completion of these laboratory exercises, you should be able to: 1. Identify various anatomical structures of the axial skeleton. 2. Determine functional classification and anatomical motions that occur at specified joints. 3. Define key terms related to muscular function, including origin, insertion, agonist, antagonist, prime mover, and synergist. 4. Discuss the various muscles of the axial skeleton in terms of anatomy and function. 5. Identify the various anatomical structures on specific medical imaging tools such as MRIs and XRays. K EY S TRUCTURES Vertebral Column (33) Vertebrae • Atlas • Axis • Body of the vertebra • Intervertebral foramen • Vertebral foramen • Spinous process • Transverse process • Articular facet joint • Intervertebral disc (1) Sacrum (1) Coccyx Thoracic Cage Bones/Joints Kinesiology Terms Sternum • Manubrium • Body • Xiphoid process (12 paired) ribs • True ribs (ribs 1–7) • False ribs (ribs 8–12) • Floating ribs (ribs 11–12) (12) Thoracic vertebrae Costal cartilage Appendicular skeleton Axial skeleton Bone classification by shape • Long • Short • Irregular • Flat • Sesamoid Articulation terms • Synarthrosis • Amphiarthrosis • • • • • Diarthrosis Fibrous Cartilaginous Synovial Bursae E XERCISE 1. A XI AL S KELETON ( OVERVIEW ) PROCEDURE Obtain the following models: human skull, full skeleton, bone box with individual bones, and a flexible spine model. Read the following text and identify the following bold print anatomical structures on the different models. Label the Figures 2.1 and 2.2. Students are responsible for familiarizing themselves with all of the appropriate laboratory models. THE SKELETAL SYSTEM There are 206 bones in the adult human skeleton. The bones of the human body are characterized by shape or physical characteristics. The major bone classifications are long, short, irregular, flat, and sesamoid. Long bones have a long slender shape and are found in the arms, legs, thighs, fingers, and toes. Short bones are approximately equal in length and width. They can be found in the wrist and ankle. Flat bones have flat thin surfaces, which are found in the skull, sternum, and ribs. Irregular bones have complex shapes with many bumps and ridges. The vertebrae of the spinal column and sphenoid bone of the skull are considered to be irregular bones. Sesamoid bones are located where tendons cross over joints. They typically function to increase the mechanical advantage of a muscle. In other words, this type of bone aligns the muscle’s tendon to be in a position where it can generate more force. The patella is considered a sesamoid bone. The forces placed on the skeleton ultimately will dictate the shape of the bones. These forces include both gravitational and muscular stressors. Notice the prominent ridges on many of the bones of the body. These ridges are usually the result of powerful muscles, which pull on these bones to create movement. The skeleton can be divided into an appendicular and axial skeleton. The appendicular skeleton is composed of the pectoral (shoulder), pelvic girdles (hip), and bones of the extremities. The appendicular skeleton will be covered in more detail in the next laboratory. The axial skeleton is composed of the bones of the skull, hyoid, vertebrae, ribs, sternum, sacrum, and coccyx. The skull alone is composed of 22 bones. It can be divided into the cranium, which encases the brain, and facial bones. With the exception of the temporomandibular joint, the bones of the skull are connected by relatively immovable joints called sutures. A more detailed description of the different joints will be discussed later in the lab. Locate the various models and photos of the skull placed around the lab. Record the letter to the corresponding structures. Use illustrations from figures 2.1 and 2.2 as a reference. T OPIC REVIEW QUESTIONS . 1. List the five classifications of bones by shape. Provide one example for each classification. __________________________________________________________________________ __________________________________________________________________________ 2. What type of forces act on the bones that will influence their shape? __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ E XERCISE 2. A XI AL S KELETON (E X AM INATION OF THE S PINE ) The spine typically has an S-shaped configuration. In both the cervical and lumbar spine, the curve projects anteriorly (lordosis). The thoracic spine’s curve projects posteriorly (kyphosis) (Figure 2.3). These curves naturally develop as a result of the stresses of weight bearing. Variations in spinal curves may be seen in people with scoliosis (excessive curving of the spine laterally) or osteoporosis (collapsing of the vertebra, typically seen in the thoracic vertebra, creating an excessive thoracic spine kyphosis). THE VERTEBRAL COLUMN The vertebral column consists of 24 individual articulating vertebrae, the sacrum, and the coccyx. These bones function to protect the spinal cord and are important sites of muscular attachment, making movement of the spine and maintaining an upright posture possible. The 24 individual vertebrae are divided into 3 major areas. There are 7 vertebrae located in the neck called cervical vertebrae. Just inferior to the cervical vertebrae are the 12 thoracic vertebrae. Finally, the lumbar vertebrae make up the last 5 non-fused vertebral bones located in the lower back area. The most caudal portion of the spinal column is composed of 2 fused bones called the sacrum superiorly and coccyx inferiorly. The vertebrae of these two bones are considered fused because they do not contain an intervertebral disc between them. There are 33 bones total that make up the vertebral column, if you count the 5 sacral and 4 coccygeal bones. FIGURE 2.4. Most vertebrae have several characteristic features with slight variations in anatomy due to location and regional functions (Table 2.2 and Figures 2.4-2.7). The body of the vertebra is located anteriorly and is designed for weight bearing. The size of the body is proportional to the amount of weight it needs to support. The vertebral foramen is located posterior to the body. The spinal cord and its nerve roots occupy this space. The spinous process is the prominent projection that can be palpated and seen posterior in the midline. These are very visible when asking a thin person to bend forward. They serve as attachment sites for many muscles and ligaments that support the spine. The transverse processes are the lateral projections off the vertebra. They also serve as attachment sites for many muscles and ligaments that support the spine. The lamina is the portion of bone that connects the spinous and transverse processes. Articular facets are projections off the body that enable the vertebra to move in relation to each other. The superior articular facet of the bottom vertebra will articulate with the inferior articular facet of the top vertebra. The facet joints are important for movement such as bending and rotating. The sacrum is a bone composed of five-fused vertebra that articulate with L5 (lowest lumbar vertebra) superiorly and the coccyx inferiorly. There are four pairs of sacral foramen that allow both blood vessels and nerves to pass into the lower extremities. The coccyx is also known as the tailbone. The atlas and axis ( Figure 2.5) are considered atypical vertebrae. The atlas is the first cervical vertebra (C1). It lacks a vertebral body. The only structure it needs to support is the skull. The superior articular facet of the atlas articulates with the occipital condyles at the base of the skull. (Remember, the ancient Greek god Atlas holds up the world—so the atlas holds the skull.) The axis is the second cervical vertebra (C2). The odontoid process (dens) is unique to this vertebra. It projects superiorly to articulate with the atlas. Fifty percent of the rotation in the cervical spine occurs between the atlas and axis. The articulation between the atlas and axis is called the atlanto-axial joint. TABLE 2.2 Regional variation of vertebrae Structure 7 Cervical 12 Thoracic 5 Lumbar Body Smallest Medium Largest Transverse process Transverse foramina for vertebral artery Contains articular facets for ribs on transverse process on all vertebrae except for the 11th and 12th rib Thin and long Spinous process Short and bifid (two points) Long and projects inferiorly Short and thick Figure 2.5 Typical Cervical Vertebrae Figure 2.6 Thoracic Vertebrae Figure 2.7 Lumbar Vertebrae [ Sacrum / Coccyx FIGURE 2.9 [ILLUSTRATION] Intervertebral discs are located between the vertebral bodies. These provide cushioning and space which allows for both mobility of the spine and a space (intervertebral foramen) for the peripheral nerves to exit the spinal column. The intervertebral disc is composed of two parts. The annulus fibrosus is the tough, outer layer that anchors the vertebra together while allowing for a small degree of movement. The nucleus pulposus is located in the center of the disc. It contains a viscous gelatinous substance that contributes to both the height and shock-absorbing qualities of the disc. Clinical application: A herniated disc can occur if there was trauma to the outer annulus. This allows for the nucleus pulposus to get pushed out posteriorly, putting pressure on the nerve exiting the spine). The disc height will also become diminished, resulting in a smaller intervertebral foramen, which can also compress the nerves exiting the spine at that level. A laminectomy is a surgical procedure in which the lamina is removed to help decompress the spinal nerves at the level of compression. Figure 8.22c [ Figure 2.10 Vertebral Column Identify the following anatomical structures listed from Table 2.3 on the various models located throughout the lab. Place the corresponding letter in the table below. Structures Vertebrae bodies Cervical vertebrae Lumbar vertebrae Thoracic vertebrae Body of vertebra Spinous process Transverse process Intervertebral foramen Intervertebral disc Articular facet joints Sacrum Coccyx Letter T ABLE 2.3 E XERCISE 3. A XI AL S KELETON (E X AM INATION OF THE T HORACIC C AGE ) The thoracic cage consists of the sternum, ribs, and thoracic vertebrae (Figure 2.12). They collectively function to protect the organs in the thoracic cavity. The sternum (breast bone) is a flat bone created by the fusion of the manubrium (superior), body (middle), and xiphoid process (inferior). There are 12 pairs of ribs that help protect the organs in the thoracic cavity. The first 7 ribs, known as the true ribs, directly attach to the sternum via the costal cartilage. Ribs 8–12 are considered false ribs because they attach indirectly to the sternum or have no sternal attachments at all. Ribs 11 and 12 are considered floating ribs, because they have no attachments to either the sternum or adjacent ribs. FIGURE 2.12. The Rib Cage Identify the following anatomical structures listed from Table 2.4 on the various models located throughout the lab. Place the corresponding letter in the table below. Structures Costal cartilage Xiphoid process Transverse process of vertebra Body of vertebra Body of sternum Manubrium True ribs False ribs Letter Floating ribs T ABLE 2.4 Assessment of the Spinal Column Obtain the flexible spine model. Identify the following anatomical landmarks on the model. 1. Which anatomical structure exits the intervertebral foremen? ______________________________ __________________________________________________________________________ 2. Move the lumbar spine into both flexion and extension. Describe the motions effect on the articular facet joints and the size of the intervertebral foremen. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3. Clinical thinking question. If the intervertebral disc experienced significant degeneration, which is characterized by a reduction in disc height, what effect would this now have on the intervertebral foramen? Which spinal motion would most likely affect the anatomical structure that exits the intervertebral foramen? __________________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Appendicular Skeleton K EY S KELETAL S TRUCTURES OF THE U PPER AND L OWER E XTREMITIES Bones of the Shoulder Complex and Arm Forearm and Hand Bones Anatom y of the Pelvis and Thigh Anatom y of the Knee, Leg, and Foot Scapula Radius Hip Patella • Glenoid cavity • Radial tuberosity • Innominate Tibia • Acromion process • Styloid process of radius • Pelvis • Medial malleolus • Coracoid process Ulna • Ilium • Tibial tuberosity • Spine of the scapula • Olecranon process • Ischium Fibula Clavicle • Styloid process of ulna • Ischial tuberosity • Lateral malleolus Manubrium Humeroradial joint • Pubis Hindfoot Acromioclavicular joint Humeroulnar joint • Pubic symphysis • Talus Sternoclavicular joint Radioulnar joint • Acetabulum • Calcaneus Glenohumeral joint Carpal bones: Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate Sacrum Midfoot Sacroiliac joint • Tarsus (Tarsal bones) Coccyx • Cuboid Femur • Navicular • Greater trochanter • Cuneiform bones: medial, intermediate, and lateral Humerus • Greater tubercle • Lesser tubercle • Deltoid tuberosity • Bicipital groove • Lateral epicondyle • Medial epicondyle Metacarpal bones Proximal phalangeal bones Middle phalangeal bones Distal phalangeal bones Distal interphalangeal joint • Capitulum Metacarpophalangeal joints • Trochlea Proximal interphalangeal joint • Olecranon fossa • Lesser trochanter • Medial epicondyle Forefoot • Lateral epicondyle • Metatarsal bones • Medial condyle • Proximal, middle, and distal phalangeal bones • Lateral condyle E XERCISE 1. THE U PPER E XTREMITY THE SCAPULA, CLAVICLE, AND HUMERUS Identify the scapula on the full skeleton. It is a flat irregular-shaped bone, which serves as an attachment site for 17 different muscles (Figure 3.2). The scapula is considered a floating bone because it does not directly attach to the skeleton. The scapulothoracic joint is not a true joint because it doesn’t contain a joint capsule or have ligamentous attachments. The anterior surface of the scapula articulates with the posterior surface of the rib cage. Palpate the prominent bony horizontal ridge (spine) on the back of the scapula. The spine ends laterally at the acromion process. The acromion process connects to the clavicle at the acromioclavicular joint (Figure 3.1). The medial end of the clavicle connects to the manubrium (superior part of the sternum), forming the sternoclavicular joint. The scapula’s medial (vertebral) border runs parallel to the vertebral column. The lateral (axial) border is easy to feel in the axillary area (arm pit). On the anterior surface of the scapula is the coracoid process. This serves as an important site of muscular attachment. The glenoid cavity (fossa) is the concave surface that the head of the humerus articulates with forming the glenohumeral joint (shoulder joint). (Figure 3.2) [ FIGURE 3.1. FIGURE 3.3. Scapula The humerus has prominent ridges on the proximal end called the greater and lesser tubercle (Figure 3.4). These ridges are attachment sites for the rotator cuff muscles, which play an important role in stabilizing the humerus especially during overhead activity. The groove that runs between these ridges is called the intertubercular (bicipital) groove. The tendon of the long head of the biceps brachii runs through this groove. The deltoid tuberosity is located on the lateral, proximal 1/3 portion of the humerus. It is the insertion for the deltoid muscle. Identify the medial epicondyle and lateral epicondyle at the distal end of the humerus. They are easy to palpate on either side of your elbow. The elbow is composed of three different joints. Move the skeleton’s elbow through its normal range of motion. Notice the depression on the posterior distal end of the humerus (olecranon fossa). When the elbow is flexed, the olecranon fossa is visible. During elbow extension, it will be covered by the olecranon process of the ulna. The articular surface at the distal end of the humerus is divided into a capitulum and trochlea. The capitulum articulates with the radius laterally forming the humeroradial joint. The trochlea articulates with the ulna medially forming the humeroulnar joint. The primary motion that occurs at these two joints are flexion and extension. The 3rd joint of the elbow complex is the proximal radioulnar joint. Notice the motion between the proximal radius and ulna when you move the forearm through both pronation and supination. FIGURE 3.4. Humerus FOREARM AND HAND The forearm is formed by both the radius laterally and ulna medially (Figure 3.5). Remember these descriptors are based on the body being in the anatomical position. Notice the proximal radius is smaller than the proximal ulna. However, the opposite is true at the distal ends of these bones. Move the elbow through both pronation and supination. Notice how the radius moves on the ulna (radioulnar joint). Identify a prominent bump on the proximal radius (radial tuberosity). This is the insertion for the biceps brachii muscle. The distal ends of both the radius and the ulna are called styloid processes. Notice the carpal bones just distal to the styloid processes of the ulna and radius (Figure 3.5). The proximal row of carpal bones, starting from the thumb side, are the scaphoid, lunate, triquetrum, and pisiform. The distal row of carpal bones includes the trapezium, trapezoid, capitate, and hamate. These are the bones that make up the wrist. They serve as points of muscular attachments. The palmar side of the carpal bones is covered with a fibrous connective tissue called the flexor retinaculum, which makes up the roof of the carpal tunnel. The finger flexor tendons and median nerve run through this tunnel. The hand consists of five metacarpals. The metacarpals articulate with five proximal phalanges forming the metacarpophalangeal joints. With the exception of the thumb, each finger is composed of proximal, middle, and distal phalangeal bone. The articulation between the proximal and middle phalanges is called the proximal interphalangeal joint. The articulation between the middle and distal phalanges is called the distal interphalangeal joint. The metacarpophalangeal and interphalangeal joints are responsible for the hand’s ability to grip objects. Notice the absence of a middle phalanx in the thumb. Therefore, there is also no proximal interphalangeal joint in the thumb. FIGURE 3.5. Radius and Ulna. Anterior View FIGURE 3.6. Forearm and Hand. Common Injuries of the Upper Extremity The shoulder and elbow are commonly injured areas. Rotator cuff muscle (RC) tears result from a combination of poor posture and repetitive overhead movements. The RC muscles are particularly vulnerable to injury underneath the acromion process of the scapula. The humerus impinges on the acromion compressing the tendons of the RC. This type of injury is often referred to as a shoulder impingement. The elbow is also susceptible to overuse injuries. The medial epicondyle (medial epicondylitis) can become inflamed when the forearm flexors are overused, such as in golfing and pitching. The lateral epicondyle can become inflamed when the wrist extensors are overused, such as in playing tennis. This can result in lateral epicondylitis. Carpal tunnel syndrome is a condition in which there is compression of the median nerve, usually associated with repetitive movements of the wrist. Swelling and inflammation results, compressing the median nerve as it runs through the carpal tunnel. Surgical intervention consists of a surgeon making small slits in the flexor retinaculum to help reduce the pressure on the nerve within the tunnel. Figure 3.7 Figure 3.7 Identify the following anatomical structures listed from Table 3.1 on the various models located throughout the lab. Place the corresponding letter in the table below. Structure Sternoclavicular Joint Letter Acromioclavicular joint Glenohumeral joint Humerus Ribs Scapula Radial tuberosity Acromion process Coracoid process Radius Lateral epicondyle Medial epicondyle Olecranon fossa Carpal bones Metacarpal bones Proximal phalangeal bones Middle phalangeal bones Distal phalangeal bones Ulna Humeroulnar joint Radioulnar joint Humeroradial joint Olecranon process Table 3.1 E XERCISE 4. T HE B ONES OF THE P ELVIS AND L OWER E XTREMITIES PROCEDURE Obtain both a full skeleton and a bone box. Identify the pelvic girdle (pelvis) (Figure 3.10). It is designed to support the weight of the upper body while dealing with ground reaction forces that are transmitted through the lower extremities during weightbearing activities. The pelvic girdle consists of the two hip bones (innominate), sacrum and coccyx. Recall the sacrum was inferior to the last lumbar vertebra. The coccyx is attached to the sacrum caudally. The innominate is composed of three bones that have fused together (ilium, pubis, and ischium). First identify the sacroiliac joint connecting the ilium to the sacrum. Place your hands on the crescent-shaped ilium, which flares out laterally on each side of the sacrum. Strong ligaments connect these 2 bones together, both anteriorly and posteriorly. The pubis is the anterior, inferior portion of the innominate. A fibrocartilage disc joins the two pubic bones together at the pubic symphysis. The ischium is the posterior and inferior portion of the innominate. The ischial tuberosity (sit bone) is the most prominent portion of the ischium. There are many powerful muscles of the posterior and medial thigh originating here. The pubis, ilium, and ischium form a deep concave surface called the acetabulum (hip socket). The hip joint is classified as a synovial joint that provides both increased range of motion (ROM) and structural stability. Its increased ROM can be attributed to the ball-and-socket architecture of the joint. The stability of the joint comes from both the deep hip sockets and the strong muscles and ligaments that surround it. FIGURE 3.10. The lower extremity can be divided into the thigh (between the hip and the knee) and the leg (knee to the ankle). The femur is the largest and one of the strongest bones in the body. The 3 anatomical parts of the femur are the head, neck, and shaft (Figure 3.11). The head to the femur articulates with the acetabulum forming the hip joint. The neck of the femur connects the shaft to the head. The neck of the femur is susceptible to fracture in the elderly. The greater trochanter and lesser trochanter are key insertion points for muscles that stabilize the hip. The patella (knee cap) articulates within a groove (patellar surface) between the medial and lateral condyles of the femur. The medial and lateral epicondyles are located superior to the condyles. The quadriceps femoris is composed of 4 muscles that cover the anterior surface of the femur. They directly attach to the patella via the quadriceps tendon. FIGURE 3.11. BONES OF THE LEG The tibia is connected to the patella by the patellar tendon. Recall tendons are the dense regular connective tissue that connects muscle to bone. The patellar tendon is technically a ligament because it connects 2 bones together. The knee joint is the articulation of the femur and tibia. The lateral and medial condyles of the tibia articulate with the lateral and medial condyles of the femur. The tibia is the major weight-bearing bone in the leg (Figure 3.13). Move your hands anterior and inferior to a prominent bump called the tibial tuberosity. It is just inferior to the patella and acts as a common attachment for the quadriceps femoris muscles of the anterior thigh. The medial malleolus is the medial and distal portion of the tibia. The fibula is thinner and lateral to the tibia. It is considered a non-weightbearing bone. The proximal fibula head is a site of muscle attachment. The distal end of the fibula terminates at the lateral malleolus. The talus sits in between both malleoli. FIGURE 3.13. The foot and ankle are made up of 26 bones, held together by many ligaments (Figure 3.14). The foot is divided into 3 distinct areas. The hindfoot (calcaneus and talus) connects the foot to the lower leg. Dorsi and plantar flexion result from the gliding of the tibia over the talus. The midfoot includes the cuboid, navicular, and the 3 cuneiform bones (medial, intermediate, and lateral). It forms the arches of the foot, which function in shock absorption during gait. These 7 bones are sometimes referred to as the tarsal bones (tarsus). The forefoot consists of the remaining long bones of the foot (5 metatarsals, 5 proximal, 4 middle, and 5 distal phalanges). Notice the first metatarsal is much larger than the others. The size of this bone reflects its importance in weight bearing, especially during walking. Toes 2–5 are composed of 3 separate phalangeal bones while the first toe is only composed of 2 phalangeal bones (no middle phalanx). FIGURE 3.14. Identify the following anatomical structures listed from Table 3.4 on the various models located throughout the lab. Place the corresponding letter in the table below. Structure Ilium Pubis Ischium Sacrum Sacroiliac joint Acetabulum Coccyx Greater trochanter Collateral ligaments Tarsal bones Pubic Symphysis Letter/ Cruciate ligaments Tibia Fibula Metatarsal bones Tibialfemoral joint Femoral acetabular joint Calcaneus Talus Patella Phalanges Tibial tuberosity Femur Femur head Meniscus Table 3.4 Upper Extremity Review Structure Clavicle 1. Description The bone that connects the manubrium to the scapula Acromioclavicular joint 2. Articulation between the humerus and ulna Glenohumeral joint 3. Upper arm bone Humerus 4. Articulates with the head of the humerus Ribs Scapula 5. 6. Articulation between the scapula and clavicle 12 pair of bones Radial tuberosity Acromion process 7. 3. Just Distal to proximal phalangeal bone. Location of pain for someone with tennis elbow Coracoid process Radius Lateral epicondyle 9. 10. 11. Location for pain for someone with pitcher’s (golfers) elbow. Just distal to metacarpal bones Prominent feature on the anterior portion of the scapula 12. Lateral bone of the forearm 13. 14. 15. Posterior depression on the distal humerus Articulation between the humerus and scapula Most distal bones of the hand 16. Just distal to the carpal bones 17. Short bones of the wrist Medial epicondyle Olecranon fossa Carpal bones Metacarpal bones Proximal phalangeal bones Middle phalangeal Number bones Distal phalangeal bones 13. Ulna 19. Superior ridge of scapula which is located above the head of the humerus Articulation between the radius and ulna Humeroulnar joint 20. Shoulder blade bone Radioulnar joint 21. Articulation between the humerus and radius Humeroradial joint 22. Medial bone of the forearm Olecranon process 23. Proximal ulna / insertion of triceps brachii Lower Extremity Review Structure Ilium Number 1. Description The bone that connects the manubrium to the scapula Pubis 2. Articulates with the tibia Ischium 3. Inferior to L5 vertebrae Sacrum 4. Inferior to the sacrum Sacroiliac joint 5. Anterior pelvic bones Acetabulum 6. Articulation between the sacrum and the Ilium Coccyx 7 Hip joint Greater trochanter 3. Articulation between the pubic bones Lesser trochanter Tarsal bones Pubic Symphysis 9. 10. 11. Ankle joint Knee joint Insertion for iliopsoas muscle Talocrural joint 12. Bones of the midfoot Tibia 13. Weight bearing bone of the leg Fibula 14. Posterior pelvic bones (sit bones) Metatarsal bones 15. Superior to the sacrum Tibialfemoral joint 16. Bones of the forefoot Femoral acetabular joint 17. Non-weightbearing bone of the leg Lumbar vertebrae 13. Insertion for gluteal muscles Calcaneus 19. Anatomical pulley for quadriceps muscle Talus 20. Articular surface of hip joint Patellar 21. Found in children Epiphyseal plate 22. Found in adults Epiphyseal line 23. Largest bone in the body Femur 24. Articulates with the acetabulum Femur head 25. Common site of fractures in the elderly Femur Neck 26. Attachment site for the Achilles tendon