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ANAT30008 LECTURE NOTES PART 2 Lecture 18 – Bones and joints of pelvis • This is the intact bony pelvis and it is comprised of a pair of hip bones together with the sacrum and coccyx posteriorly • There is a synovial sacroiliac joint laterally • Anteromedially, there is is a secondary cartilaginous joint called the pubic symphysis • The hip bone is made up of 3 fused bones: ischium, ilium and pubis • The acetabulum and the obturator foramen are formed by the 3 fused bones Ilium • This is made up of the iliac crest superiorly and this extends between the ASIS and the posterior superior iliac spine • There are also 3 surfaces o Gluteal surface gives rise to the gluteal muscles o Iliac fossa which gives rise to iliacus o Sacral surface which includes the articular surface for the sacroiliac joint Pubis • The pubic bone is made up of the pubic body with the pubic crest on top and 2 rami – superior pubic ramus and inferior pubic ramus • The body of each pubic bone articulates at the midline at the pubic symphysis • The superior surface that is the pubic crest is continuous with the pubic tubercle. This surface is also continuous with the pectineal line (lacunar ligament pans inward from the medial part of the inguinal ligament that went to the pectineal line of the pubis) Ischium • This is made up of a body and single ramus • 2 bony features of the ischium o The ischial tuberosity – this gives attachments to the hamstrings group o Ischial Spine – this separates the greater sciatic notch above from the lesser sciatic notch below • Acetabulum forms the socket f the hip joint and this is formed by the union of ischium o During development we have a tri-radiate cartilage inserted here separating the 3 bones *but ultimately they fuse) • Obturator foramen – this is part of the wall of the pelvis o This is a large opening bounded by the rami of the pubis and the ramus of the ischium Hip bone Sacrum and coccyx Sacroiliac joint Pubic symphysis acetabulum obturator foramen

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Page 1: ANAT30008 LECTURE NOTES PART 2 Lecture 18 – …Drake R L, Vogl W, Mitchell A W M. Gray’s Anatomy For Students. Churchill Livingstone; 2nd ed. 2010. ISBN 9780808924067. p.423 fig

ANAT30008LECTURENOTESPART2Lecture18–Bonesandjointsofpelvis

• Thisistheintactbonypelvisanditiscomprisedofapairofhipbonestogetherwiththesacrumandcoccyxposteriorly

• Thereisasynovialsacroiliacjointlaterally• Anteromedially,thereisisasecondarycartilaginousjointcalledthepubic

symphysis

• Thehipboneismadeupof3fusedbones:ischium,iliumandpubis• Theacetabulumandtheobturatorforamenareformedbythe3fused

bonesIlium

• ThisismadeupoftheiliaccrestsuperiorlyandthisextendsbetweentheASISandtheposteriorsuperioriliacspine

• Therearealso3surfaceso Glutealsurfacegivesrisetothe

glutealmuscleso Iliacfossawhichgivesriseto

iliacuso Sacralsurfacewhichincludesthe

articularsurfaceforthesacroiliacjoint

Pubis

• Thepubicboneismadeupofthepubicbodywiththepubiccrestontopand2rami–superiorpubicramusandinferiorpubicramus

• Thebodyofeachpubicbonearticulatesatthemidlineatthepubicsymphysis• Thesuperiorsurfacethatisthepubiccrestiscontinuouswiththepubictubercle.Thissurfaceisalso

continuouswiththepectinealline(lacunarligamentpansinwardfromthemedialpartoftheinguinalligamentthatwenttothepectineallineofthepubis)

Ischium

• Thisismadeupofabodyandsingleramus• 2bonyfeaturesoftheischium

o Theischialtuberosity–thisgivesattachmentstothehamstringsgroupo IschialSpine–thisseparatesthegreatersciaticnotchabovefromthelessersciaticnotchbelow

• Acetabulumformsthesocketfthehipjointandthisisformedbytheunionofischiumo Duringdevelopmentwehaveatri-radiatecartilageinsertedhereseparatingthe3bones*but

ultimatelytheyfuse)• Obturatorforamen–thisispartofthewallofthepelvis

o Thisisalargeopeningboundedbytheramiofthepubisandtheramusoftheischium

Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, Plate # 335B

Hip bone Sacrum and coccyx

Sacroiliac joint

Pubic symphysis The hip bone is made up of 3 fused bones: ischium, ilium and pubis

acetabulum

obturator foramen

Drake R L, Vogl W, Mitchell A W M. Gray’s Anatomy For Students. Churchill Livingstone; 2nd ed. 2010. ISBN 9780808924067. p.423 fig. 5.20

Drake R L, Vogl W, Mitchell A W M. Gray’s Anatomy For Students. Churchill Livingstone; 2nd ed. 2010. ISBN 9780808924067. p.424 fig. 5.21

Page 2: ANAT30008 LECTURE NOTES PART 2 Lecture 18 – …Drake R L, Vogl W, Mitchell A W M. Gray’s Anatomy For Students. Churchill Livingstone; 2nd ed. 2010. ISBN 9780808924067. p.423 fig

Sacrum• Thisisatriangularbonemadeupof5fused

vertebraeandtheyareoriginaltransverseprocesses.

o Originaltransverseprocessesfusetogethertoformalateralmassandthesuperiorsurfaceofthelateralmassiscalledthesacralala

o Sacralala=thetopofthefusedtransverseprocessesofthesacralvertebraethatcometogether

• TheSuperiorsurfacealsohasamidlineprominencecalledthesacralpromontory.Thesacralalasitsoneithersideofthis

• Sacrumarticulatesabovewiththelumbar-sacraljointabove,belowwiththecoccyxviathesacrococcygealjointandlaterallywiththeileumoneithersideofthesacroiliacjoint

• Iliaccrestandiliacfosseprojectupof

thepelvicbrim• Everythingabovethepelvicbrimis

calledthefalsepelvisorgreaterpelvis(includingiliaccrestandiliacfosse)

• Everythingbelowthepelvicbrimiscalledthetruepelvisorlesserpelvis

• Thelinedelineatingthefalsepelvisfromthetruepelvisistheiliopectinealline.Thisisbasicallythecontinuationofthepectineallineofthepubis

• Thisispartoftheposteriorabdominalwallastheiliacusstartswithinhere

• Thefalsepelvisisreallyconsideredpartoftheposteriorabdominalwallanditformsaprotectionfortheabdominalviscera(andhasnothingtodowiththepelviccontents)

• Thetruepelvis(includingthesacrumandthecoccyx)sitsbetweenthepelvicinletandpelvicoutlet• Tracingalongthepelvicbrim:

o Pelvicinletisboundedbythepubiccrestanteriorly.Thenitfollowsthepectineallineofthepubis.Thereisanarchofthepelvicinletcalledthearcuatelineoftheilium.Thenwegettosacralalaandintothesacralpromontory

Pelvictypes(basedonshapeofinlet)

• Theydifferinshapes• Females–pelvicinletisovalinshapeandwidertransversely–thisisthewidest

transversediameterofthepelviscavity–importantforchildbirtho Gynaecoid–classicfemalepelvicinlet

• Maleo typicalpelvictypeisandroido anthropoidisalsoacommonvariant

• Therearealsootherwaysthatmaleandfemalepelviscandiffer[diagram]

male female

general structure thick and heavy thin and light shape of inlet heart shaped transverse oval greater sciatic notch narrow inverted v almost 90deg subpubic arch acute angle obtuse angle acetabulum large small obturator foramen round oval

The width of the acetabulum when compared to the width of the pubic bone is a particularly reliable index of male and female differences. In the female the distance from acetabulum to pubic symphysis is greater than the width of the acetabulum. In the male it is about the same.

An@tomedia: Pelvis Systems

1

2

3

4

5

c

promontory ala ala

Sacrum

Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, Fig. 457B & 335B

lateral mass

lateral mass

LSJ

SCJ

SIJ

An@tomedia: Pelvis Systems

Pelvis (from Latin) = basin

Divided into ‘false’ (greater) & ‘true’ (lesser) pelvis

Iliopectineal line demarcating false pelvis above from true pelvis below

Drake R L, Vogl W, Mitchell A W M. Gray’s Anatomy For Students. Churchill Livingstone; 2nd ed. 2010. ISBN 9780808924067. p.429 fig. 5.28

An@tomedia: Pelvis Systems

Pelvis (from Latin) = basin

Divided into ‘false’ (greater) & ‘true’ (lesser) pelvis

Iliopectineal line demarcating false pelvis above from true pelvis below

Drake R L, Vogl W, Mitchell A W M. Gray’s Anatomy For Students. Churchill Livingstone; 2nd ed. 2010. ISBN 9780808924067. p.429 fig. 5.28

Pelvic types (based on shape of inlet)

An@tomedia: Pelvis Systems

~50%

~30%

~20%

~2%

Page 3: ANAT30008 LECTURE NOTES PART 2 Lecture 18 – …Drake R L, Vogl W, Mitchell A W M. Gray’s Anatomy For Students. Churchill Livingstone; 2nd ed. 2010. ISBN 9780808924067. p.423 fig

• Thereisvariationinthegeneralstructure,shapeofinlet,angulationofthegreatersciaticnotch,inthesub-pubicarch,thesizeoftheacetabulumandthesizeoftheobturatorforamen

• Thewidthoftheacetabulumwhencomparedtothewidthofthepubicboneisaparticularlyreliableindexofmaleandfemaledifferences.Inthefemale,thedistancefromacetabulumtopubicsymphysisisgreaterthanthewidthoftheacetabulum.Inthemaleitisaboutthesame

Pubicinlet/outlet

• Pelvicoutletisdiamondshaped• Thisisdefinedasextendingfromthepubicsymphysis

anteriorlytothetipofthecoccyxposteriorly,andeithersidearetheischialtuberosity’s

• Therearevariationsindimensionbetweenmaleandmalebutdiamondshapeisconserved

• Babiesneedtogointhroughtheinletandoutthroughtheoutlet• Planeofleastdimensionpassesthroughtheischialspine,S4andbaseofpubicbone(thisiswherethe

babiesheadgoesthrough)• Duringchildbirth,thebabiesheadrotatesconstantlyandflextopresentsitsnarrowestpartofthebody

(whichisthehead)tothenarrowestopeningofthepelvisJointsofthepelvis

• Thejointsofthepelviscompriseofapairofsynovialjointslaterally(sacroiliacjoints)andsecondarycartilaginousjointsinthemidline(pubicsymphysis)

• Thesacroiliacjointisasynovialjointo Articularsurfaceisanear

shapedsurface/auricularsurfaceoftheposteriorpartofthealaofthesacrumandearshapedsurfaceoftheilium

• Mostimportantpartofthesacroiliacjointsarethesupportingstructures

• Sacroiliacligamentsattachdirectlyanteriorlybetweenthesacrumandtheilium–thisiscalledtheanteriorsacroiliacligament

• Sacroiliacligamentsbehindarecalledposteriorsacroiliacligaments• Theseanteriorandposteriorsacroiliacligamentspassacrossthefrontoftheanteriorandposteriorpartsof

thejointreinforcingthecapsule

Pelvic inlet, narrow pelvic plane & outlet

An@tomedia: Pelvis Systems

The plane of least dimensions passes through the ischial spine, S4 & base of pubic bone

Pelvic inlet, narrow pelvic plane & outlet

An@tomedia: Pelvis Systems

The plane of least dimensions passes through the ischial spine, S4 & base of pubic bone

Pelvic inlet, narrow pelvic plane & outlet

An@tomedia: Pelvis Systems

The plane of least dimensions passes through the ischial spine, S4 & base of pubic bone

Pelvic inlet/outlet

An@tomedia: Pelvis Systems

Drake R L, Vogl W, Mitchell A W M. Gray’s Anatomy For Students. Churchill Livingstone; 2nd ed. 2010. ISBN 9780808924067. p.427 fig. 5.24


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