Bones, ligament, joints of thelower limb

Pelvis

Pavel ŠNAJDR

ilium

pubisischium

Pelvis – 3+1 bones

hip bone with sacrum -SI jointtwo hip bones - symphysis

true (or lesser) pelvis –bony canal throughwhich the child passes during birth.

SI jointalmost immobile kloub (amphiarthrosis)auricular surfaces of both bones

strong capsule –sacroiliac lig. (ventr., dors., interosseous) iliolumbar lig. connecting the ilium to the L4,L5

sacrotuberous and sacrospinous ligg.

symphysis pubis

-cartilagineous interpubic disk with smallnonsynovial cavity

superior and inferior pubic ligament

obturator membrane -obturator canalfor obturator blood vessels and nerve

suprapiriformforamens.g.v. and n.

infrapiriformforameni.g.v. and n.

i.p.v. and p.n.

s.n. , p.f.c.n.

Sex differences of the pelvis

female: wider, transversely directed obturatorforamina, pubic arch

lesser pelvis is larger than in male

male: longitudinally orientated obturatorforamina, subpubic angle

subpubic angle x pubic arch

True pelvis

4 planes, baby´s headhas to descendduring birth

The biggestdiameter of thenewborn´s head fits intothe biggestdiameter of each plane

Pelvic measurements in obsterics (and anatomy)stright, obligue and transverse diameter1.pelvic inlet – promontory, iliopectineal

lines, symphysis/ tr. dia.–13 cm/2.pelvic cavityamplitudo – S2-3, acetabulum, center of

symhysis/ obl. dia..-13,5 cm/angustia - spina ischiadica, sacrum, lower

end of symphysis / str. dia. –11,5 cm/3. pelvic outlet - 2 triangles – pubic arch,

ischial tuberosities, coccyx / str. dia.–11,5 cm/

inlet

outletangustia

true (obstetric) conjugate – from retropubic eminence to promontory 10,5 cmdiagonal conjugate – lower edge of symphysis to promontory –13cm

external pelvic meauserments:interspinous distance – 26 cmintercristal distance – 29 cmintertrochanteric distance – 31 cmexternal conjugate (Badelocque) – upper edge of symphysis to spinous

process of L5, 18-20 cm

coxa valga

coxa vara

angle of inclination 125-130

hip jointknee jointprox. and dist. tibiofibular jointtalocrural (ankle) jointsubtalar + talocalcaneonavicularcalcaneocuboidtarsometatarsal jointmetatarsophalangeal jointinterphalangeal joint

Hip jointball and socket joint

femoral head–lunate surface of acetabulumadditional features: acetabular lip (labrum),

transverse acetabular lig.

reinforcing ligg.: iliofemoral lig. pubofemoral lig. ischiofemoral lig. zona orbicularislig. of the head of F

Movements

flexion/extensionabduction/adduction

rotationcircumduction

cemented non-cemented prosthesis

Knee jointcomplex joint: femorotibial +femoropatellar

femoral condyles – tibial condylesincongruence of their surfaces is compensated by

menisci med. + lat.

patellar surface of F -articular surface of P

Ligaments 1

patellar lig.med. + lat. patellar retinaculumtibial collateral lig.fibular collateral lig.oblique popliteal lig.arcuate politeal lig.

Ligaments 2

anterior cruciate lig. posterior cruciate lig. transverse lig. of the kneeant. + post. meniscofemoral lig.

synovial and fibrous layer of capsule are separated - cruciate ligg are intracapsular but extra-articularly

infrapatellar fat pad

synovial bursae

movements

flexion/extension combined with rotationgliding and rolling movements

extended knee is in locked position (medial rotation of F)- initial phase of flexion is unlocking (untwisting)

process (lateral rotation of F)

forced abduction/adduction

arthroscopy

proximal T-F jointhead of F- fib.art.facet of lat.tib.condyle

interosseous membrane

dist. T-F joint = tibiofibularsyndesmosis - special kind of connection allowing minimal movement essential for proper ankle joint function

ant. + post.tibiofibular ligg.

Ankle (talocrural) joint

trochlea(pulley) of T - malleolar mortise(deep socket)

medial = deltoid lig.(4 parts) lateral lig. (3 parts)

movement: plant.flexion/dors. flexion

Deltoid (medial) ligament- tibionavicular part- ant. tibiotalar part - tibiocalcaneari part- post. tibiotalar part

Lateral ligament- ant. talofibular ligament

-post. talofibular lig. -calcaneofibular lig.

.

subtalar joint (post.articular

facets of T and C)talocalcaneonavicularcalcaneocuboidform functional complex allowing

eversion/inversion of foot

Chopart´s joint line = transverse tarsal jointcomplex of C-C and T-N joint

bifurcate lig. (calcaneonavicular + calcaneocuboid)

Lisfranc´s joint line - complex of tarsometatarsals and intermetatarsals joints

MTT2 projects proximally !

Great number of short ligg. connecting leg bones to tarsals, connecting tarsals between themselves,

connecting tarsals and metatarsals

plantar aponeurosis, long plantar lig., plantar calcaneonavicular (spring) lig., short plantar ligg.

Foot (plantar) archestarsal and MTT bones are arranged in longitudinal

(med. , lat.) and transverse arches with shock absorbing, weight bearing function

are maintained by:1. Shape of interlocking bones2. Strength of the plantar ligg. + plantar aponeurosis3. Action of tendons of muscles – tibialis ant. and post., peroneus longus and btrevis, flexors of the foot