THE LOWER LIMB: BONES AND JOINTS

Sacroiliac

– sacrum and ilium

Symphysis pubis

– between pubic bones

Hip joints

– hip bone and femur

Knee joints

– femur and tibia

Proximal tibiofibular

upper tibia and fibula

Distal tibiofibular

lower tibia and fibula

Ankle or talocrural

– talus, tibia and fibula

Intertarsal joints

– between adjacent tarsal bones

Tarsometatarsal joints

– each foot between tarsals and metatarsals

Intermetatarsal joints

– each foot between adjacent metatarsals

Metatarsophalangeal joints

– each foot between adjacent metatarsals

Interphalangeal joints

* each foot
* Proximal
* Distal

Hip bone

* Os coxae, innominate bone
* A large irregular bone that connects the lower limb to the trunk.

acetabulum

– a deep circular cup shaped depression on the lateral surface of the hip bone below its middle.

Acetabular notch

– a gap on the inferior margin of the rim of acetabulum

Acetabular fossa

– a flat central part of the acetabulum

Obturator foramen

– large opening in the inferior part of the hip bone between the pubis and ischium

Ilium

Or flank bone, it forms the upper two-fifths of the acetabulum, and all of the hip bone above it.

Ala or wing

– is the thin flattened upper part of the ilium above the body

Iliac crest

– upper curved border of the ala.

Iliac fossa

– concave inner surface of the wing of ilium.

Auricular surface

– a rough, ear-shaped part posterior to the iliac fossa that articulates with the upper lateral part of the sacrum.

Ischium

Forms the lower two-fifths of the acetabulum and that part of the hip bone below and dorsal to the acetabulum

Ischial spine

– pointed process that extends dorsally and medially from the body of the ischium.

Ischial tuberosity

– large rounded process on the posterior surface of the lower end of the body of ischium

Pubis

Forms the anterior one-fifth of the acetabulum and the anterior part of the hip bone in front of the acetabulum and obturator foramen.

Pubic tubercle

– a very small process on the superior margin of the pubic bone slightly lateral to the pubic symphysis.

Pubic crest

– small ridge on the upper margin extending from the symphysis to the pubic tubercle.

Pubic arch

– is the curved surface formed by the medial margins of both inferior rami of the pubic bones and the lower border of the symphysis pubis.

Pelvis

(L = basin) a hollow curved cylinder with bony walls, at the inferior end of the vertebral column.

Linea terminalis (terminal line)

– a ridge of bone that begins at the upper margin of the symphysis pubis.

Superior aperture (opening)

– pelvic rim or inlet. Heart-shaped opening into the true pelvis.

Inferior aperture or outlet

– an opening at the lower end of the pelvis composed of the incomplete bony ring and ligaments.

True pelvis

–or minor pelvis, is the cavity located between the inlet and outlet.

False pelvis

–or major pelvis, lies above the plane of the inlet.

Greater Sciatic notch

– a deep notch on the posterior margin of the hip bone.

female

The hips in the ____ appear to be more prominent, the iliac crest are flared outward more, and they are less curved.

Femur

Is a long bone, and the longest bone in the body, extending from the hip to the knee.

Fovea capitis femoris

– small but definite hole at the center of the head.

Greater trochanter

– large prominence on the lateral surface of the upper femur.

Lesser trochanter

– much smaller rounded process that extends medially from the posteromedial margin of the upper femur at the junction of the neck and shaft.

Intertrochanteric crest

– is a ridge of bone that passes obliquely across the back of the upper femur between the greater and lesser trochanters.

Intertrochanteric line

– a ridge that extends obliquely across the anterior surface of the upper femur.

Linea aspera

– a double bony ridge that passes longitudinally down the posterior surface of the body of femur

Medial condyle

– rounded knoblike process that forms the medial part of the distal end of the femur.

Lateral condyle

– rounded process forming the lateral part of the distal end of the femur.

Intercondylar fossa

– a deep notch located between the posterior parts of the femoral condyles.

Adductor tubercle

– a small process on the medial surface of the medial epicondyle.

Patella

Is a sesamoid bone lying within the tendon of the quadriceps muscle tendon. It is a flat rounded bone and lies anterior to the knee joint.

Tibia

Large sturdy bone and lies medial to the fibula.

Intercondylar eminence

– a small, double pointed process on the proximal end of the tibia, located between the articular surfaces of the medial and lateral condyles of the tibia.

Tibial tuberosity

– rounded prominence on the anterior surface of the tibia below the condyles.

Fibular articular surface (fibular facet)

– a small, smooth rounded area on the posterolateral border of the lateral tibial condyle.

Inferior articular surface

– a four sided smooth surface on the distal end of the tibia.

Medial malleolus

– projects down from the medial margin of the tibia. It reaches about one-half inch below the level of the ankle joint

Fibular notch

– a concave depression on the lateral surface of the tibia just above the ankle joint.

Fibula

Long slender bone lying on the lateral side of the tibia and parallel to it.

Apex or styloid process of the fibula

– pointed upper end of the head.

Lateral malleolus

– distal expanded end of the fibula. Its tip is at lower level than the medial malleolus.

Talus

Or astragalus is sometimes referred to a ankle bone. It lies between the distal end of the tibia and the calcaneus, transmitting body weight to the calcaneus.

Trochlea

– upper smooth convex surface that articulates with the lower end of the tibia.

The head

– rounded anterior end of talus

Calcaneus

* Largest tarsal bone and forms the heel.
* Its upper surface has 3 smooth areas that form joints with the talus.

Calcaneal tuberosity

– enlarged posterior end

Sustentaculum tali

– small but definite shelf of bone that projects medially from the medial surface of the calcaneus immediately below the talus, which it helps to support.

Sesamoid bones

Often present in tendons on the plantar surfaces of the metatarsophalangeal joint of the great toe, second toe and sometimes in other toes.

Patella

– largest sesamoid bones

Fabella

– frequently present posterior to and above the lateral condyle of the femur.

Sacroiliac joints

– gliding joint (some authorities classified it as cartilaginous) O Auricular surface of the sacrum O Auricular surface of ilium

Pubic Symphysis

* cartilaginous joint
* Adjacent medial margins of the pubic bones

Hip joints or coxal joints

* ball and socket joint
* Head of the femur
* Cup shaped acetabulum of the hip bone

Round ligament (ligamentum teres)

– or the ligament of the femoral head is attached to the pit on the femoral head above and to the acetabular notch of the hip bone below.

Knee joints

* hinge, double condylar, gliding joint
* Medial and lateral condyles of the femur articulating the medial and lateral condyle of tibia
* Patellar surface of the femur articulating with the patella

Menisci or semilunar cartilages

– 2 flat half-moon shaped discs of cartilage with the knee joint.

Cruciate ligaments

– two band of fibrous tissue that pass up from the intercondylar part of tibia, one to each margin of the intercondylar fossa.

The tendon of the quadriceps femoris muscle

– is attached to the base of the patella

Patellar ligaments

– extends from the apex of the patella to the tibial tuberosity.

Superior tibiofibular joints

* gliding joint
* Fibular articular surface of the tibia
* Articular surface on the medial margin of the head of fibula

Inferior tibiofibular joints

* cartilaginous joints
* Medial surface of the lower part of fibula
* Fibular notch of the tibia

Ankle joint

* hinge joint
* Inferior articular surface of the tibia articulating with the trochlea of the talus, and the medial and lateral malleoli with the medial and lateral surfaces of the talus

Longitudinal arch and Transverse arch

The Arches of the Foot

Longitudinal arch

* Visible when the foot is viewed on the medial border.
* Formed by the tarsal and metatarsal bone

Transverse arch

Curved from the medial side of the plantar surface to the lateral margin of the foot

Congenital dislocation

– femoral head lies outside of and above the acetabulum.

Congenital Anomalies of the Pelvis and Lower Limb

Absence of one or both patellae

Bipartite patella

– patella may present as 2 separate bones

Os trigonum

– a small triangular bone posterior to the talus has formed from a separate epiphysis to that of the talus, and has failed to unite with it.

Accessory navicular bone

– the posteromedial part of the navicular bone may be separate from the main part of this bone.

Landmarks of the Pelvis

O Iliac crest
O ASIS
O PSIS
O Ischial tuberosity
O Sacroiliac joints
O Symphysis pubis
O Pubic arch
O The greater trochanter
O Head of femur

Landmarks of the Knee

O Patella
O Tibial tuberosity
O Knee joint
O Condyles
O Epicondyles
O Head of fibula

Landmarks of the ankle

O Medial malleolus

O Lateral malleolus

O Ankle joint

O Calcaneal tuberosity

O Tuberosity of the 5th metatarsal bone

O Metatarsophalangeal joints

Radiography of the Pelvis and Lower Limb

O Sacroiliac joints

O Hips or innominate bones

O Neck of the femora

O Patella

O Knee joint

O Ankle joint

O Calcaneus

O Metatarsal bones