Pelvic girdle
 Attaches lower limbs to the spine
 Supports visceral organs
 Attaches to the axial skeleton by strong
ligaments
 Acetabulum is a deep cup that holds the head
of the femur
Pelvic girdle
 Consists of paired hip bones (coxal bones)
 Hip bones unite anteriorly with each other
 Articulates posteriorly with the sacrum
Pelvic girdle
Hip bones
 Consist of three separate bones in childhood
 Ilium, ischium, and pubis
 Bones fuse – retain separate names to
regions of the coxal bones
 The triradiate cartilage
 Acetabulum
 A deep hemispherical socket on lateral pelvic
surface
ilium
 The ilium is a large flaring bone that forms
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the superior region of the coxal.
It consists of a body and superior wing like
portion called the ala
The broad posterolateral surface is called the
gluteal surface
The auricular surface articulates with the
sacrum (sacroiliac joint)
Major markings include the iliac crests, four
spines, greater sciatic notch, iliac fossa,
arcuate line
Lateral view
Medial View
Ischium
 Forms posteroinferior region of the coxal
bone
 Anteriorly – joins the pubis
 Ischial tuberosities
 Are the strongest part of the hip bone
Pubis
 Forms the anterior region of the coxal bone
 An angulated bone
 Lies horizontally in anatomical position
 Pubic symphysis (fribrocartilage)
Lateral and Medial Views of
the Hip Bone
True and False Pelves
 Bony pelvis is divided into two regions
 False (greater) pelvis – bounded by alae of the
iliac bones
 True (lesser) pelvis – inferior to pelvic brim
 Forms a bowl containing the pelvic organs
True and False Pelves
Comparison of Male and Female
Pelvic Structure
 Female pelvis
 –Tilted forward, adapted for childbearing
 –True pelvis defines birth canal
 –Cavity of the true pelvis is broad, shallow,
and has greater capacity
 Male pelvis
 –Tilted less forward
 –Adapted for support of heavier male build
and stronger muscles
 –Cavity of true pelvis is narrow and deep
Characteristic
Female
Male
Bone thickness
Lighter, thinner, and
smoother
Heavier, thicker, and more
prominent markings
Pubic arch/angle
80°–90°
50°–60°
Acetabula
Small; farther apart
Large; closer together
Sacrum
Wider, shorter; sacral
curvature is accentuated
Narrow, longer; sacral
promontory more ventral
Coccyx
More movable; straighter
Less movable; curves
ventrally
Thigh
 The region of the lower limb between the hip
and the knee
 Femur – the single bone of the thigh
 Longest and strongest bone of the body
 Ball-shaped head articulates with the acetabulum
femur
 Longest bone in the body
 Heaviest bone
 Has a head with a fovea called pit
 Proximal end has two trochanters (greater
and lesser)
 Neck is trapezoidal
 angle of inclination between the long axis of
the head and the proximal end and the shaft
Femur cntd
 Lesser trochanter is posterior medial (flexors
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of thigh)
Greater trochanter is lateral(abductors and
rotators of thigh)
Intertrochanteric line (iliofemoral ligament)
Intertrochanteric crest
Quadrate tubercle and trochanteric fossa
Shaft is smooth anteriorly and convex
Posteriorly the shaft has a linea aspera
Femur contd
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Medial and lateral condyles
Intercondylar fossa
Patella surface
Medial and lateral epicondyle
Adductor tubercle
Structures of the Femur
Patella
 Triangular sesamoid bone
 Imbedded in the tendon that secures the
quadriceps muscles
 Protects the knee anteriorly
 Improves leverage of the thigh muscles
across the knee
Leg
 Refers to the region of the lower limb
between the knee and the ankle
 The leg is fixed in permanent pronation
 Composed of the tibia and fibula
 Tibia – more massive medial bone of the leg
 Receives weight of the body from the femur
 Fibula – stick-like lateral bone of the leg
 Interosseous membrane- Connects the tibia
and fibula
tibia
 Has 2 condyles- medial and lateral
 Intercondylar eminence
 Shaft has 3 surfaces- medial, lateral and
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posterior
Anterior border is most prominent and also
called the shin or shin bone
Extends distally to form the medial malleolus
Fibular notch
Posterior surface has a soleal line
Nutrient foramen
Structures of the Tibia and
Fibula
fibula
 Lies posteriolateral
 Leg is fixed in permanent pronation
 Distal end ends in lateral malleolus
 Shaft has 3 borders (anterior, posterior and
interosseous) and 3 surfaces (medial,
posterior and lateral)
Anterior view
posterior view
The Foot
 Foot is composed of
 Tarsus, metatarsus, and the phalanges
 Important functions
 Supports body weight
 Acts as a lever to propel body forward when
walking
 Segmentation makes foot pliable and adapted to
uneven ground
Tarsus
 Makes up the posterior half of the foot
 Contains seven (7)bones called tarsals
 Talus, calcaneous, cuboid, navicular, 3
cuneiforms
 Body weight is primarily borne by the talus
and calcaneus
Metatarsus
 Consists of five small long bones called
metatarsals
 Numbered 1–5 beginning with the hallux
(great toe)
 First metatarsal supports body weight
Phalanges of the Toes
 14 phalanges of the toes
 Smaller and less nimble than those of the fingers
 Structure and arrangement are similar to
phalanges of fingers
 Except for the great toe, each toe has three
phalanges
 Proximal, middle, and distal
Bones of the Foot
Bones of the Foot
Bones of the Foot
fractures of the femur
 Mostly age and sex related (elderly females >60) due
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osteoporosis
Most common site is the neck
Proximal femoral fractures
 Transcervical fracture-femoral neck (avascular
necrosis occurs due to retinacular arteries that are cut
off from the medial circumflex femoral artery)
 Inter trochanteric fracture
Femoral shaft fracture
 spiral fracture (leads to foreshortening)
Distal femoral fractures
 Fracture of femoral condyles- popliteal artery runs on
the posterior surface
Fractures of tibia and fibula
Tibial and fibula fracture
 The tibial shaft is narrowest at the junction of
its middle third and inferior thirds and most
frequent site of fracture.
 Poor blood supply
 nutrient artery (nutrient canal posteriorly)
 Types
 Compound fracture (with external bleeding)
 Diagonal fracture with shortening
 Transverse fractures (with fibular intact)
 March (stress) fracture
Fibula neck fracture
Direct trauma as nerve
passes superficially
around neck of fibula
Foot drop and loss of
eversion
May cause sensory loss
over lateral leg and
dorsum of foot
Fracture of Lateral
malleolus
Fibular
malleolar
fracture effectexcessive
inversion of foot
Common in
soccer and
football players
JOINTS OF THE LOWER LIMB
HIP JOINT, KNEE JOINT and
ANKLE JOINT
 Type
 Articulation
 Capsule
 Ligaments
 Movements
 Blood Supply
 Nerve Supply
Hip Joint
 The hip joint forms the
connection between the
lower limb and the pelvic
girdle
HIP JOINT
 TYPE:
BOLL & SOCKET TYPE
 ARTICULATIONS :
Cup shaped acetabulum &
Hemi spherical head of femur
Acetebular surface is horseshoe shaped
Cavity is deepended by – fibro cartilagenous rim
called “ Acetabular labrum”
5 IN NO.
1. ILIO-FEMORAL LIGAMENT:
- Strong, inverted “y” shaped Lig.
- Base is above – from AIIS
- 2 limbs are below from –
upper & lower parts of Inter –
trochanteric line
2. PUBO - FEMORAL LIGAMENT:
- Triangular in shape
Base – superior ramus of pubis
Apex – Lower part of Inter trochanteric line
Limits – extension & abduction
LIGAMENTS
3. ISCHIOFEMORAL LIGAMENT:
- Spiral shaped ligament
- Acetabular margin of Ischium &
greater trochanter
- limits extension
4. TRANSVERS ACETABULAR LIGAMENT:
- formed between the acetabular labrum ends
- Bridges the acetabular notch
5. Lig. OF HEAD OF FEMUR:
- Flat, triangular ligament
- apex – pit on the head of femur
- base – transvers Lig. & acetabular margins
MOVEMENTS:
 FLEXION:
 EXTENSION:
 ABDUCTION:
 ADDUCTION:
 LATERAL ROTATION:
 MEDIAL ROTATION:
 CIRCUMDUCTION:
Blood Supply of the Hip Joint
 The medial and
lateral circumflex
femoral arteries
 The artery to the
head of the femur
Avscular Necrosis of head
 More common >60 years
 In female for
osteoporosis
 Supplied mainly by
Medial circumflex
femoral artery by its
retinacular branches
 Blood supplied through
round ligament of
femur(br. Of Obturator)
is grossly inadequate.
Hip Joint Replacement
 A metal prosthesis
anchored to femur by
bone cement
 A plastic socket is
cemented to
acetabulum
 Posterior dislocation
 Posterior tearing of joint
capsule
 Dislocated femoral head
lies on posterior surface
of ischium
 Occurs in head-on collision
 Complications
 Sciatic nerve may
damage.
POSTEIOR DISLOCATION of hip joint can lead to
sciatic nerve injury. Most common manifestation is
foot drop due to damage to common fibular part
Relatively Rare phenomena
KNEE JOINT
 TYPE :
Femoro-Tibial joint – Synovial joint of Hinge variety
Patello-Femoral joint – Synovial joint of gliding variety
. ARTICULATIONS :
1. Femoro-Tibial joint :
Above – Femoral condyles
Below – Tibial condyles & their
Cartilaginous menisci
2. Patello-Femoral joint :
Above – Posterior surface of
patella
Below – Patellar surface of lower
end of femur
The articular surfaces are lined with Hyaline cartilage
LIGAMENTS
I. EXTRACAPSULAR LIGAMENTS:
1. Ligamentum patellae:Attachments
Above – Lower border of patella
Below – Tibial tuberosity
It is a continuation of the central portion of
common tendon of Quadriceps femoris
2. Lateral collateral ligament:
card like
above – Lateral condyle of femur
below – Head of fibula
I. EXTRACAPSULAR LIGAMENTS:
3. Medial collateral ligament:
is flat band like
above – Medial condyle of femur
below – medial surface of shaft
of tibia
It is firmly attached to the edge of the
medial meniscus
II.INTRACAPSULAR LIGAMENTS:
CRUCIATE LIGAMENTS:
* Main lig.’s Bound between femur &
tibia throughout joint range.
1.A.C.L.
Attachments:
below – Anterior intercondylar area of
tibia
above – posterior part of medial
surface of lateral femoral condyle
It prevents forward displacement of
Tibial condyles
2.P.C.L.:Attachments:
below – posterior inter
condylar area of tibia
above – anterior part of
lateral surface of medial
femoral condyle
It prevents backward
displacement of tibial
condyles and anterior
displacement of femur on
the tibia
It prevents posterior pulling
of tibia when the knee is
flexed
3.Medial Meniscus and
4.Lateral Meniscus
 “C” shaped fibro cartilaginous sheets
 Peripheral border is thick & attached to capsule
 Inner border is thin, concave & free
 Upper surface – in contact with femoral condyles
 Lower surface – in contacts with tibial condyles
 Function :
Shock absorbing cushion between two bones
MOVEMENTS:
 FLEXION
 EXTENSION
 MEDIAL ROTATION
 LATERAL ROTATION
Unhappy triad(TCL,MEDIAL
MENISCUS AND ACL)
Knee Joint Injuries
 Anterior drawer
sign: This injury
causes the free
tibia to slide
anteriorly under
the fixed femur.
Posterior drawer sign:
 PCL ruptures
allow the free
tibia to slide
posteriorly
under the fixed
femur.
BURSAE:
 ANTERIOR SIDE:
1. SUPRA PATELLAR BURSA
2. PRE - PATELLAR BURSA
3. INFRA PATELLAR BURSA
i). Superficial
ii). Deep
Bursitis in the Knee Region
 1. Prepatellar bursitis:
Prepatellar bursitis is
caused by friction
between the skin and
the patella.
This condition has been
called housemaid's
knee.
Subcutaneous infrapatellar
bursitis
 caused by excessive
friction between the
skin and the tibial
tuberosity.
 Baker's Cyst
 Posterior herniation of synovial
membrane through joint capsule
into popliteal fossa
 Usually asymptomatic but Large
swellings may interfere with knee
movements
ANKLE JOINT
 TYPE :
– Synovial joint of Hinge variety
. ARTICULATIONS :
Above – Lower end of tibia and fibula
Below – Body of talus
The articular surfaces are lined with
Hyaline cartilage
LIGAMENTS
Medial or Deltoid ligament:
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1.Posterior tibiotalar
2.Anterior tibiotalar
3.Tibionavicular
4. Tibiocalcaneal
3
4
5
Medial ligament of the ankle
joint (Deltoid ligament)
 Lateral ligament of
the ankle joint
 1.Posterior talofibular thick
strong lig. (malle.fossa to
lat.tubercle of talus)
 2.Anterior talofibularweak
 3.calcaneofibular ligament
round cord (lat. Mall to
Lat.surface of calcaneus)
Lateral ligament of the
ankle joint.
MOVEMENTS of the Ankle Joint
 1. Dorsiflexion of the ankle
 2. Plantarflexion of the ankle
 The movements of inversion and eversion
take place at the tarsal joints and not at the
ankle joint.
Clinical Anatomy
Ankle Injuries
 The lateral ligament is
injured because it is
much weaker than the
medial ligament.
 The anterior
talofibular ligament
part of the lateral
ligament is most
vulnerable and most
commonly torn during
ankle sprains.
Pott fracture(dislocation of
the ankle)
 Occurs when the foot
is forcibly everted.
 Trimalleolar fracture:
 The combined fracture
of the medial
malleolus, lateral
malleolus, and the
posterior margin of
the distal end of the
tibia is known as a
"trimalleolar fracture
Arches of the Foot
 The bones of the foot do not lie in a
horizontal plane. Instead, they form
longitudinal and transverse arches relative to
the ground.
 The arches distribute weight over the pedal
platform (foot), acting not only as shock
absorbers but also as springboards for
propelling it during walking, running, and
jumping.
Longitudinal arch
 The longitudinal arch of the foot is formed
between the posterior end of the calcaneus
and the heads of the metatarsals.
 It is highest on the medial side where it forms
the medial part of the longitudinal arch and
lowest on the lateral side where it forms the
lateral part.
Arches of the foot.
Transverse arch
 The transverse arch of the foot runs from side
to side
 It is formed by the cuboid, cuneiforms, and
bases of the metatarsals. The medial and
lateral parts of the longitudinal arch serve as
pillars for the transverse arch.
Major Ligaments of the Foot
 1. Plantar calcaneonavicular ligament (spring
ligament): The spring ligament supports the
head of the talus and plays important roles in
the transfer of weight from the talus and in
maintaining the longitudinal arch of the foot,
of which it is the keystone (superior most
element).
 2. Long plantar ligament
 3. Plantar calcaneocuboid ligament (short
plantar ligament).
Support for arches of the
foot
Clinical Anatomy
 1.Hallux Valgus:
 Hallux valgus is a foot
deformity caused by
pressure from
footwear and
degenerative joint
disease; it is
characterized by
lateral deviation of
the great toe
Flatfeet
 Flatfeet can
either be flexible
(flat, lacking a
medial arch,
when weight
bearing but
normal in
appearance
when not
bearing weight
or rigid (flat even
when not
bearing weight).
Genu Varum and Genu Valgum
The Q-angle
Genu varum
 Genu varum (also
called bow-leggedness), is a
physical deformity marked
by (outward bowing) of
the leg in relation to
the thigh, giving the
appearance of an archer's
bow.
Genu valgum
 Genu valgum,
commonly called
"knock-knees", is a
condition where
the knees touch one
another when
the legs are
straightened.