Bones, ligament, joints of the lower limb
Pelvis
Pavel ŠNAJDR ilium
Pelvis – 3+1 bones hip bone with sacrum -SI joint two hip bones - symphysis true (or lesser) pelvis –bony canal through which the child passes during birth .
SI joint almost 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 small nonsynovial cavity superior and inferior pubic ligament
obturator membrane -obturator canal for obturator blood vessels and nerve suprapiriform foramen s.g.v. and n. infrapiriform foramen i.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 obturator foramina, pubic arch lesser pelvis is larger than in male
male: longitudinally orientated obturator foramina, subpubic angle subpubic angle x pubic arch True pelvis 4 planes, baby´s head has to descend during birth The biggest diameter of the newborn´s head fits into the biggest diameter of each plane Pelvic measurements in obsterics (and anatomy) stright, obligue and transverse diameter 1.pelvic inlet – promontory, iliopectineal lines, symphysis/ tr. dia.–13 cm/ 2.pelvic cavity amplitudo – 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
angustia outlet true (obstetric) conjugate – from retropubic eminence to promontory 10,5 cm diagonal conjugate – lower edge of symphysis to promontory –13cm external pelvic meauserments: interspinous distance – 26 cm intercristal distance – 29 cm intertrochanteric distance – 31 cm external conjugate (Badelocque) – upper edge of symphysis to spinous process of L5, 18-20 cm angle of inclination 125-130
coxa valga
coxa vara hip joint knee joint prox. and dist. tibiofibular joint talocrural (ankle) joint subtalar + talocalcaneonavicular calcaneocuboid tarsometatarsal joint metatarsophalangeal joint interphalangeal joint
Hip joint ball and socket joint femoral head–lunate surface of acetabulum additional features: acetabular lip (labrum), transverse acetabular lig.
reinforcing ligg.: iliofemoral lig. pubofemoral lig. ischiofemoral lig. zona orbicularis lig. of the head of F Movements
flexion/extension abduction/adduction rotation circumduction cemented non-cemented prosthesis
Knee joint complex joint: femorotibial +femoropatellar
femoral condyles – tibial condyles incongruence of their surfaces is compensated by menisci med. + lat. patellar surface of F -articular surface of P Ligaments 1 patellar lig. med. + lat. patellar retinaculum tibial collateral lig. fibular collateral lig. oblique popliteal lig. arcuate politeal lig.
Ligaments 2 anterior cruciate lig. posterior cruciate lig. transverse lig. of the knee ant. + post. meniscofemoral lig.
infrapatellar fat pad
synovial and fibrous layer of capsule are separated - cruciate ligg are intracapsular but extra-articularly synovial bursae movements
flexion/extension combined with rotation gliding 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 joint head of F- fib.art.facet of lat.tib.condyle interosseous membrane dist. T-F joint = tibiofibular syndesmosis - 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) talocalcaneonavicular calcaneocuboid form functional complex allowing eversion/inversion of foot Chopart´s joint line = transverse tarsal joint complex 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) arches tarsal 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 bones 2. Strength of the plantar ligg. + plantar aponeurosis 3. Action of tendons of muscles – tibialis ant. and post., peroneus longus and btrevis, flexors of the foot