FEMUR 2
(MYOLOGY AND CLINICAL ANATOMY)
OBJECTIVES
By the end of the lecture students should be able to:
Know the attachments of the different muscles and ligaments on the bone
Know the arterial supply of the bone
Get the general idea about fractures of femur and other clinical conditions
LECTURE OULINE
Muscle attachments on femur posteriorly
Muscle attachments on femur anteriorly
LIGAMENTS OF THE NECK
Capsule of the hip joint
The iliofemoral ligament(of Bigelow)
The pubofemoral ligament
The ischiofemoral ligament (only reaches the zona orbicularis)
The ligament of the head, the ligamentum teres.
MUSCLES OF THE NECK
The lower part the neck RECIEVES the tendon of obturator externus.
ATTACHMENTS ON THE GREATER TROCHANTER
The diagonal impression RECIEVES the tendon of the Gluteus medius
The triangular area on lateral surface if smooth holds the bursa between the bone and
gluteus medius
if rough receives a part of the muscle
Area below and behind the diagonal impression receives tendon of gluteus maximus
The trochanteric fossa (digital fossa) RECIEVES the tendon of the Obturator
externus
Above and in front of this the Obturator internus and Gemelli are inserted.
The superior border RECIEVES insertion of the Piriformis
The inferior border gives origin to the upper part of the Vastus lateralis
The anterior border affords insertion at its lateral part to the Gluteus minimus.
ATTACHMENTS ON UPPER END OF FEMUR
ATTACHMENTS ON THE LESSER TROCHANTER
The summit of the trochanter gives insertion to the tendon of the Psoas major
The linea quadrata, and gives attachment to the Quadratus femoris and a few fibers
of the Adductor magnus.
The tubercle of femur is the point of meeting of five muscles: the Gluteus minimus
laterally, the Vastus lateralis below, and the tendon of the Obturator internus and two
Gemelli above.
The upper half of linea aspera affords attachment to the iliofemoral ligament of the
hip-joint and its lower half gives origin to the upper part of the Vastus medialis.
A slight thickening about the middle of the intertrochanteric crest, gives attachment
to the upper part of the Quadratus femoris.
iliopsoas
ATTACHMENTS ON THE BODY OF FEMUR
The gluteal tuberosity gives attachment to part of the Gluteus maximus
Pectineal line gives attachment to the Pectineus
Between the medial ridge and the intertrochanteric line, a portion of the Iliacus is
inserted
The adductor tubercle affords insertion to the tendon of the Adductor magnus.
From the medial lip of the linea aspera, the Vastus medialis arises
From the lateral lip, the Vastus lateralis takes origin.
The Adductor magnus is inserted into the linea aspera
ATTACHMENTS ON THE SHAFT
Attachments on medial surface of Shaft
CONTD…
Between the Vastus lateralis and the Adductor magnus two muscles are attached—the
Gluteus maximus above, and the short head of the Biceps femoris below.
Between the Adductor magnus and the Vastus medialis four muscles are inserted: the
Iliacus and Pectineus above; the Adductor brevis and Adductor longus below.
From the upper three-fourths of anterior surface the Vastus intermedius arises
From the upper part of it the Articularis genu takes origin.
From the upper three-fourths of lateral surface of the body of femur the Vastus
intermedius takes origin.
Medial surface of body is covered by the Vastus medialis.
ATTACHMENTS AT THE LOWER END OF THE FEMUR
Ligaments:
The
posterior cruciate ligament of the knee-joint is attached to the lower and front
part of the medial wall of the intercondylar fossa
The anterior cruciate ligament attaches to an impression on the upper and back part of
lateral wall of the fossa.
The medial epicondyle has the tibial collateral ligament of the knee-joint is attached
to it.
The lateral epicondyle, gives attachment to the fibular collateral ligament of the
knee-joint.
Anterior view
LATERAL VIEW
Muscles at the lower end of femur:
Behind
the medial epicondyle is a rough impression which gives origin to the medial
head of the Gastrocnemius.
The Popliteus arises from the depression below the lateral condyle
Above and behind the lateral epicondyle is an area for the origin of the lateral head of
the Gastrocnemius.
Above and to the medial side of gastrocnemius, the Plantaris arises.
ARTERIAL SUPPLY OF THE FEMUR
Mainly supplied by profunda femoris
Nutrient
artery usually enters bone proximally and posteriorly along the linea aspera
Usually it comes of the 2nd perforating artery
The upper end of the femur is supplied by the nutrient artery of the shaft, the
retinacular vessels of the capsule, and the foveolar artery of the ligamentum teres.
The retinacular vessels consist of three separate groups: postero-superior,
posteroinferior, and anterior.
These vessels are the chief supply to the epiphysis and femoral head at all ages.
 The foveolar artery constitutes a small and subsidiary blood supply to the femoral
epiphysis
FRACTURES OF THE FEMUR
Types of fractures include the following:
SIMPLE - There is only one fracture line, and the bone is broken into 2 pieces.
COMMINUTED - There is more than one fracture line, and there are more than 2 bone
fragments at the fracture site.
CLOSED - The skin in the fracture area is not broken, and the break is not exposed to
the outside.
OPEN (COMPOUND) - The skin over the fracture is broken, exposing the broken
bone.
PATHOLOGICAL - The bone has been weakened or destroyed by disease so that it
breaks easily.
STRESS - There is a hairline crack in a bone, sometimes not even visible on an X-ray,
which is caused by repeated injury or stress on the bone
AVASCULAR NECROSIS OF THE HEAD OF FEMUR
The retinacular fibres hold down the arteries to the head (mostly from the trochanteric
anastomosis)
Their rupture may result in avascular necrosis of the head of the femur in
intracapsular fracture of the neck.
Revacularization of the head depends on new vessels crossing the fracture line, not on
any within the ligament of the head
OSTEOARTHRITIS OF HIP JOINT
Effects the hip joint
Extremely painful, limiting activity
A chronic disease and is characterized by destruction of cartilage, overgrowth of bone,
bone spur formation and impaired function.
This type of arthritis occurs when bone rubs against bone.
Especially in old age
LEARNING RESOURCES
Gray’s Anatomy by Henry Gray
Last’s Anatomy by R.J.Last
Netter’s Atlas by Frank H. Netter, MD