Muscles Bones of Lower Limb 2024. Bones of Lower Limb 2024

1. BONES OF LOWER LIMB

2. OBJECTIVES
• At the end of the lecture the students should be able
to:
• Classify the bones of the three regions of the lower limb
(thigh, leg and foot).
• Memorize the main features of the
– Bone pelvis
– Bones of the thigh (femur & patella)
– Bones of the leg (tibia & Fibula).
– Bones of the foot (tarsals, metatarsals and phalanges)
• Recognize the side of the bone

3. Why is the pelvis hard
• “Private parts” don’t uncover except in
most intimate setting (or medical
setting!)
• Not comfortable seeing or talking about
(except jokes)
• Now serious-many medical issues
• Realize and confront, not dehumanize--
develop professional manner and
language--starts with anatomy

4. Bony structure of the pelvis
MAIN STRUCTURES
• Hip bone (innominate, os
coxae)--fusion of
– Ilium (“hips”)
– Ischium (“rear”)
– Pubis (anterior midline)
• Sacrum and coccyx
• Acetabulum
• Femur--head, neck,
greater trochanter
HOLES
• False and true pelvis
(major, minor pelvis)
• Pelvic inlet, pelvic outlet
• Sacrotuberous ligament
• Sacrospinous ligament
• Greater, lesser sciatic
foramen
• Obturator foramen

5. Frolich, Human Anatomy, Pelvis I

6. Female bony pelvis
• False pelvis
lies above the linea terminalis
(pelvic brim)
has no obstetrical significance.
• True pelvis
Lies below linea terminalis (pelvic
brim)
has important role in child birth
It has inlet, cavity & outlet

8. True pelvis
• Pelvic inlet (superior strait)
boundaries: a. rami of Pubic bone, symphysis pubis
p. sacral promontory
l. linea terminalis
diameters:
1.anteroposterior diameter
obstetrical conjugate:
shortest distance between the promontory and symphysis pubis
normally measures 10cm or more.
(others: true conjugate & diagonal conjugate)
2.The transverse diameter
greatest distance between linea terminalis on either side
3.Rt & Lt oblique diameter
extend from one of the sacroiliac synchondroses to the iliopectineal
eminence on the other side

10. • Mid pelvis
-at the level of ischial spines
-interspinous diameter usually ~10cm
- Smallest diameter of the pelvis

11. • Pelvic outlet
-boundaries a. the area under the pubic arch
p. the tip of the sacrum
l. ischial tuberosities, sacrosciatic ligments
-diameters
1.Anteroposterior diameter(9.5-11.5)
from the lower margins of the symphesis pubis to the tip of the sacrum
2. The transverse diameter (11cm)
the distance between the inner edges of the ischial tuberositis.
3.The posterior sagittal diameter (>7.5)
from the tip of the sacrum to the line between ischial tuberositis

14. Pelvic shapes
• Caldwell-Moloy classification
-A line drawn through the greatest diameter of the inlet divides it to ant. & post.

15.  Gynaecoid pelvis:
1.It is the commonest type (50%)
2.Inlet is slightly oval or round (TD~APD)
3.Sacrum is wide with average concavity and
inclination.
4.ischial spines not prominent (transverse
diameter is = >10cm)
5.Sacro-sciatic notch is wide.
6. wide pubic arch

16.  Anthropoid pelvis:
1.It makes 25% of white & ~ 50% of nonwhite
women.
2.All anteroposterior diameters are more than
transverse diameters (Oval anteroposteriorly)
3.Ischial spines mostly prominent.
4.Sacrum is long and narrow.
5.Sacro-sciatic notch is wide.
6.Subpubic angle is narrow.

17.  Android pelvis :
1.It is~ 30% of white & ~15% 0f nonwhite women.
2.Inlet is triangular or heart-shaped with anterior narrow
apex.
3.Side walls are converging (funnel pelvis) with projecting
ischial spines.
4.Sacro-sciatic notch is narrow.
5.Subpubic angle is narrow <90o.
6.The extreme android pelvis have poor prognosis for
vaginal delivery.

18.  Platypelloid pelvis :
1.It is a flat female type, it is rarest ~3% of women
only.
2.All anteroposterior diameters are short.
3.All transverse diameters are long (oval
transverse)
4.Sacro-sciatic notch is narrow.
5.Subpubic angle is wide.
6.The sacrum usually is well curved and rotated
backward.

19. • Intermediate-type pelvis
mixed types are much more frequent than pure types.
• significant clinical points
-obstructed labor caused narrowing of midpelvis or pelvic
outlet
-obstetric conjugate can be measured radiological only,
diagonal conjugate can be estimated clinically
-ischial spins can be felt with vaginal exam
-most important test for pelvic adequacy is labor progress it
self

20. Clinical estimation of pelvic size

21. • Best test of pelvic adequacy is progress of labor it self
• History of vaginal delivery of average weight fetus means the pelvic
is adequate.
• Pelvic inadequacy: -big baby
-small pelvis
-abnormal position

22. Frolich, Human Anatomy, Pelvis I
Female Male
 Cavity is broad, shallow
 Pelvic inlet oval + outlet round
 Bones are lighter, thinner
 Pubic angle larger
 Coccyx more flexible, straighter
 Ischial tuberosities shorter, more
everted
 Cavity is narrow, deep
 Smaller inlet + outlet
 Bones heavier, thicker
 Pubic angle more acute
 Coccyx less flexible, more curved
 Ischial tuberosities longer, face
more medially

23. BONES OF THIGH
(Femur and Patella)
Femur:
 Articulates above with
acetabulum of hip bone
to form the hip joint.
 Articulates below with
tibia and patella to form
the knee joint.

24. BONES OF THIGH
(Femur and Patella)
• Femur :
Consists of :
• Upper end
• Shaft
• Lower end

25. UPPER END OF FEMUR
• Head :
• It articulates with acetabulum
of hip bone to form hip joint.
• Has a depression in the
center (fovea capitis), for
the attachment of ligament of
the head.
• Obturator artery passes
along this ligament to supply
head of femur.
• Neck :
• It connects head to the shaft.
NECK

26. UPPER END OF FEMUR
• Greater & lesser
trochanters :
• Anteriorly,
connecting the 2
trochanters.
the inter-trochanteric
line, where the
iliofemoral ligament
is attached.
• Posteriorly, the inter-
trochanteric crest,
on which is the
quadrate tubercle.

27. SHAFT OF FEMUR
• It has 3 surfaces:
• Anterior, Medial
and Lateral.
• It has 3 borders:
• 2 rounded medial
and lateral, and a
thick posterior
border or ridge
called linea
aspera.

28. • Anteriorly : is smooth and
rounded.
• Posteriorly : has a ridge,
the linea aspera.
• Posteriorly : below the
greater trochanter is the
gluteal tuberosity for
attachment of gluteus
maximus muscle.
• The medial margin of linea
aspera continues below as
medial supracondylar
ridge.
• The lateral margin becomes
continues below with the
lateral supracondylar ridge.
• A Triangular area, the
popliteal surface lies at the
lower end of shaft.
SHAFT OF FEMUR

29. LOWER END OF FEMUR
• Has lateral and
medial condyles,
separated anteriorly
by articular patellar
surface, and
posteriorly by
intercondylar notch
or fossa.
• The 2 condyles take
part in the knee joint.
• Above the condyles
are the medial &
lateral epicondyles.

30. PATELLA
• It is a largest sesamoid
bone (lying inside the
Quadriceps tendon in
front of knee joint).
• Its anterior surface is
rough and subcutaneous.
• Its posterior surface
articulates with the
condyles of the femur to
form knee joint.
• Its apex lies inferiorly
and is connected to
tuberosity of tibia by
ligamentum patellae.
• Its upper, lateral, and
medial margins give
attachment to
Quadriceps femoris
muscles.

31. • Head is directed
upward &
Medially.
• Shaft is smooth
and convex
anteriorly.
• Shaft is rough
and concave
posteriorly.
POSITION OF FEMUR (RIGHT OR LEFT)

32. BONES OF LEG
(TIBIA AND FIBULA)
• Tibia :
• It is the
medial bone
of leg.
• Fibula :
• It is the lateral
bone of leg.
• Each of them
has upper
end, shaft,
and lower
end.

33. TIBIA
Upper end has:
• 2 tibial condyles:
• Medial condyle : is larger
and articulate with medial
condyle of femur. It has a
groove on its posterior surface
for semimembranosus ms.
• Lateral condyle : is smaller
and articulates with lateral
condyle of femur.
It has facet on its lateral side
for articulation with head of
fibula to form proximal tibio-
fibular joint.
• Intercondylar area :
is rough and has intercondylar
eminence.

34. Shaft has:
• Tibial tuberosity :
• Its upper smooth part gives
attachment to ligamentum
patellae.
• Its lower rough part is
subcutaneous.
• 3 borders :
• Anterior boder : sharp and
subcutaneous.
• Medial border.
• Lateral border interosseous
border.
• 3 surfaces :
• Medial : subcutaneous.
• Lateral
• Posterior has oblique line,
soleal line for attachment of
soleus muscle
TIBIA

35. Lowe end:
• Articulates with talus for
formation of ankle joint.
• Medial malleolus:
– Its medial surface is
subcutaneous.
– Its lateral surface
articulate with talus.
• Fibular notch: lies on its
lateral surface of lower end
to form distal tibiofibular
joint.
TIBIA

36. POSITION OF TIBIA
(RIGHT OR LEFT)
• Upper end is larger
than lower end.
• Medial malleolus is
directed downward
and medially.
• Shaft has sharp
anterior border.

37. FIBULA
• It is the selender
lateral bone of the leg.
• It takes no part in
articulation of knee
joint.
• Its upper end has :
• Head : articulates with
lateral condyle of tibia.
• Styloid process.
• Neck.

38. Shaft has :
• 4 borders : its medial
‘interoseous border gives
attachment to
interosseous membrane.
• 4 surfaces.
Lower end forms :
• Lateral malleolus :
• is subcutaneous.
• Its medial surface is
smooth for articulation
with talus to form ankle
joint.
FIBULA

39. BONES OF FOOT
7 Tarsal bones: start to
ossify before birth and end
ossification by 5th year in all
tarsal bones. They are :
1. Calcaneum.
2. Talus .
3. Navicular.
4. Cuboid.
5. 3 cuneiform bones.
• Only Talus articulates with
tibia & fibula at ankle joint.
• Calcaneum: the largest
bone of foot, forming the
heel.

40. 5 Metatarsal bones:
• They are numbered from
medial (big toe) to lateral.
• 1st metatarsal bone is
large and lies medially.
• Each metatarsal bone has
a base (proximal). a shaft
and a head (distal).
14 phalanges:
• 2 phalanges for big toe
(proximal & distal)
• 3 phalanges for each of
the lateral 4 toes
(proximal, middle &
distal)
• Each phalanx has base,
shaft and a head.
BONES OF FOOT
1 2
3
4
5

41. SUMMARY
Skeleton of lower limb consists of:
Femur: is the bone of thigh.
Tibia: is the medial bone of the leg.
Fibula: is the lateral bone of leg.
Skeleton of foot :
Tarsal bones (7 in number), calcaneum is the largest bone forming the heel.
Metatarsal bones (5 in number).
Phalanges (14 in number).
The subcutaneous parts of bones in the lower limb are:
Patella.
Anterior border of the tibia
Tibial tuberosity.
Medial malleolus of tibia.
Lateral malleolus of fibula.
The foot is a complex structure. There are 26 bones in each foot alone. The foot
is also well muscled and is supported by ligaments and tissue known as fascia.
Support is of prime importance in the foot, as it bears the weight of the body
and must adopt different configurations to permit locomotion.

42. •The patella :
•Lies on the back of the knee joint.
•Has apex lying superiorly.
•Has smooth articulating anterior surface.
•Gives attachment to quadriceps femoris tendon.
•Which one of the foot bones contributes in the ankle joint ?
•Calcaneum.
•Talus.
•Cuboid.
•Navicular.
•The tarsal bones of foot consists of :
•5 bones.
•7bones.
•9 bones.
•10 bones.

43. •Which one of the following bones is the largest bone in the
foot ?
•Cuboid.
•Cuneiform.
•Navicular.
•Calcaneum.
•Which one of the following bones forms the heel of foot?
a. Talus.
b. Calcaneum.
c. Cuboid.
d. Navicular.
The medial bone of the leg is :
•Femur.
•Humerus.
•Tibia.
•Fibula.

44. • Q.1- the clinically important important diameter in pelvic inlet is:
1-true conjugate
2-obesteric conjugate
3-diagunal conjugate
4- all of the above
• Q.2- most common type of pelvis is
1- gynecoid
2-anthropoid
3-platlypelloid
4-android
• Q.3-the narrowest diameter in the pelvis is
1-interspinous
2-anteroposterior of mid pelvis
3-oblique diameter
4.obestric conjugate
• Q.4-Which statement is incorrect
1-adequcy of female pelvis for labor can be accurately assessed by CT scan
2. progress of labor is the true assessment of female pelvis
3.labor dystocia can caused by android pelvis
4.intra labor pelvic assessment can be done

45. THANK YOU