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Los Angeles Academy of Figurative Art Kaan Yücel M.D., Ph.D. 17.February.2014 Monday inferoposterior to the abdomen transition between the trunk and the lower limbs L. Basin Right hip bone Sacrum Coccyx Left hip bone A ring of 3 bones connects the vertebral column to the two femora Right and left hip bones coxal bones; pelvic bones Sacru m Bear the weight of the upper body Transfer that weight lower appendicular skeleton Provide attachment for muscles of locomotion,posture & abdominal wall strong and rigid Contain and protect the pelvic viscera Provide support for the abdominopelvic viscera and gravid (pregnant) uterus Provide attachment for the erectile bodies of the external genitalia. Provide attachment for the muscles and membranes Superior, fan-shaped part of the hip bone Ala, or wing, of the ilium spread of the fan Body of the ilium, the handle of the fan. On its external aspect, the body participates in formation of the acetabulum. an angulated bone Superior ramus helps form the acetabulum Inferior ramus helps form the obturator foramen. Pubic crest thickening on the anterior part of the body Pubic tubercle Pubic crest ends laterally as a prominent swelling Pecten pubis Oblique ridge@ lateral part of superior pubic ramus Distinct features of the pelvic bone acetabulum obturator foramen/canal greater sciatic notch lesser sciatic notch Greater (false) pelvis Lesser (true) pelvis by the oblique plane of the pelvic inlet (superior pelvic aperture). The bony edge (rim) surrounding and defining the pelvic inlet Formed by: Promontory and ala of the sacrum A right and left linea terminalis (terminal line) formed by ischiopubic rami inferior rami of the pubis + ischium of the 2 sides. Meet @ pubic symphysis its inferior border -subpubic angle The width of the subpubic angle is determined by the distance between the right and the left ischial tuberosities, which can be measured with the gloved fingers in the vagina during a pelvic examination. Pelvic outlet (inferior pelvic aperture) bounded by: pubic arch anteriorly ischial tuberosities laterally sacrotuberous and sacrospinous ligaments posterolaterally tip of the coccyx posteriorly iliopubic eminence (iliopectineal eminence) a raised area below the anterior inferior iliac spine marks the point of union of the ilium and pubis. constitutes a lateral border of the pelvic inlet. Circular opening between abdominal cavity & pelvic cavity Formed Anteriorly by pubic symphysis Posteriorly by sacrum (promontory in the middle) Laterally by iliopectineal line Part of the pelvis superior to the pelvic inlet bounded by iliac alae posterolaterally anterosuperior aspect of the S1 posteriorly Occupied by abdominal viscera ileum and sigmoid colon. between pelvic inlet & pelvic outlet bounded by pelvic surfaces of the hip bones, sacrum, and coccyx. includes true pelvic cavity & deep parts of the perineum. Major obstetrical and gynecological significance. The blue line in this 3-D volume rendered CT image (above) represents the linea terminales that separates the false pelvis, which is above it from the true pelvis below it. The false pelvis consists of the iliac wings and has no anterior wall. The pubis bones, sacrum and coccyx, and both ischium bones delimit the false pelvis. Linea terminalis arcuate line + pecten pubis+ pubic crest Arcuate line of the ilium smooth rounded border on the internal surface of the ilium. immediately inferior to the iliac fossa. Forms part of the border of the pelvic inlet. Sexual differences are related mainly 1. Heavier build and larger muscles of most men 2. Adaptation of the pelvis (particularly the lesser pelvis) in women for parturition (childbearing). The difference between the male and female pelvis Difference Between Male & Female Pelvis male or funnel-shaped pelvis with a contracted outlet 41% of women long, narrow, and oval shaped wide pelvis 2% of women In forensic medicine (the application of medical and anatomical knowledge for the purposes of law), identification of human skeletal remains usually involves the diagnosis of sex. A prime focus of attention is the pelvic girdle because sexual differences usually are clearly visible. Even fragments of the pelvic girdle are useful in determining sex. Feature General Structure Male pelvis Female pelvis Thick & Heavy Thin & Light Greater pelvis Deep Shallow Lesser pelvis Narrow and deep, tapering Wide and shallow, cylindirical Heart-shaped, narrow Oval and rounded, wide Comparatively small Comparatively large Project further medially into the pelvic cavity Do not project as far medially into the pelvic cavity & smooth Pelvic inlet Pelvic outlet Ischial spines Feature Male pelvis Obturator foramen Round Oval Acetabulum Large Small Narrow, inverted V (approximately 70 degrees) Almost 90 degrees Smaller (50-60 degrees) Larger (80-85 degrees) Prominent Not prominent Greater schiatic notch Subpubic angle Sacral promontory Female pelvis PELVIC DIAMETERS (CONJUGATES) Size of the lesser pelvis important in obstetrics Because it is the bony canal through which the fetus passes during a vaginal birth. To determine the capacity of the female pelvis for childbearing, diameters of the lesser pelvis are noted radiographically or manually during a pelvic examination. PELVIC DIAMETERS (CONJUGATES) Diameters of pelvic outlet Antero - posterior diameters Anatomical antero-posterior diameter 11cm from tip of the coccyx to lower border of symphysis pubis Obstetric antero-posterior diameter 13 cm from tip of the sacrum to lower border of symphysis pubis as the coccyx moves backwards during the second stage of labour. Diameters of pelvic outlet Bituberous diameter 11 cm between inner aspects of ischial tuberosities Bispinous diameter 10.5 cm between tips of ischial spines Transverse diameters Diameters of pelvic inlet Antero - posterior diameters Anatomical antero-posterior diameter True conjugate 11cm from tip of sacral promontory to upper border of symphysis pubis Diameters of pelvic inlet Antero - posterior diameters Obstetric conjugate 10.5 cm from tip of sacral promontory to the most bulging point on back of symphysis pubis ,about 1 cm below its upper border. shortest antero-posterior diameter Diameters of pelvic inlet Antero - posterior diameters Diagonal conjugate 12.5 cm 1.5 cm longer than the true conjugate From tip of sacral promontory to lower border of symphysis pubis Minimum anteroposterior (AP) diameter of the lesser pelvis True (obstetrical) conjugate Narrowest distance through which the baby's head must pass in a vaginal delivery. This distance, however, cannot be measured directly during a pelvic examination because of the presence of the bladder. Diagonal conjugate (from inferior pubic lig. to promontory) Measured by palpating sacral promontory with the tip of the middle finger, using the other hand to mark the level of the inferior margin of the pubic symphysis on the examining hand. After the examining hand is withdrawn, the distance between the tip of the index finger (1.5 cm shorter than the middle finger) and the marked level of the pubic symphysis is measured to estimate the true conjugate, which should be 11.0 cm or greater. Transverse diameter is the greatest distance between the linea terminalis on either side of the pelvis.