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Lower Limb > Femur > Flashcards

Femur Flashcards

1
Q

Proximal extremity contains 6 structures

A
  • Head
  • Neck
  • Greater trochanter
  • Lesser trochanter
  • Intertrochanteric line
  • Intertrochanteric crest
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2
Q

Head of femur

A
  • Ball shaped for articulation with hip bone at acetabulum
  • 2/3 of structure is spherical and is covered by hyaline cartilage (except fovea “pit”)
  • Fovea is the site of attachment for the ligament of the head of the femur
  • The entire head structure lies in the articular capsule of the hip joint
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3
Q

Neck of femur

A
  • Joins head and shaft of bone
  • This creates a femoral angle of inclination
  • This angle is greatest at the time of birth
  • Sex and body size determine the angle
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4
Q

Normal adult values for femoral angle of inclination

A
  • Male = 125 degrees

- Female = 105 degrees

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5
Q

Angle of declination

A
  • The anterior projection of the neck from the shaft of the femur creates the angle of declination
  • The normal value for this is 12 - 14 degrees
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6
Q

Shape and surfaces of neck of femur

A
  • Hour glass shaped (thinnest in middle)

- Two surfaces: anterior and posterior

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7
Q

Anterior surface of neck of femur

A
  • Entirely enclosed in joint capsule of hip joint
  • Covex superior to inferior
  • Concave side to side
  • Many small vascular foramina
  • Intertrochanteric line
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8
Q

Intertrochanteric line

A
  • Between greater and lesser trochanters on the anterior surface of neck of femur
  • Continuous inferiorly with the spiral line
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9
Q

Posterior surface of neck of femur

A
  • More curved than anterior surface
  • Upper 1/2 to 2/3 lies in the joint capsule
  • The lower portion is grooved for the tendon of obturator externus
  • There are fewer but larger vascular foramina when compared to the anterior surface
  • Intertrochanteric crest
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10
Q

Intertrochanteric crest

A
  • Ridge of bone between greater and lesser trochanters

- Where the posterior neck joins the shaft of the femur

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11
Q

Superior border of neck of femur

A
  • Short, thick, courses horizontally

- Ends at greater trochanter

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12
Q

Inferior border of neck of femur

A
  • Long, thin, courses vertically

- Ends at lesser trochanter

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13
Q

Greater trochanter

A
  • Large, irregular, quadrilateral-shaped prominence
  • Located at the lateral end of the superior border of the neck of the femur
  • Projects laterally and posteriorly
  • Contains two surfaces: lateral and medial
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14
Q

Lateral surface of greater trochanter

A
  • Larger, palpable, quadrilateral shaped
  • Contains an oblique bony ridge for insertion of the gluteus medius
  • Bony ridge divides the lateral surface into two triangular areas, each covered by a trochanteric bursae
  • Upper triangle has a bursa for the gluteus medius
  • Lower triangle has a bursa for the gluteus maximus
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15
Q

Medial surface of greater trochanter

A
  • Trochanteric fossa is the major feature - a depression for insertion of obturator externus
  • The obturator internus tendon inserts on the anterior surface of the trochanteric fossa
  • NOTE: the superior and inferior gemelli muscles terminate and insert into the tendon of obturator internus
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16
Q

4 borders of greater trochanter

A
  • Superior
  • Inferior
  • Anterior
  • Posterior

Contain muscle attachment sites

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17
Q

Muscle attachment to superior border of greater trochanter

A
  • Piriformis muscle insertion
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18
Q

Muscle attachment to anterior border of greater trochanter

A
  • Insertion of gluteus minimus
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19
Q

Muscle attachment to inferior border of greater trochanter

A

Partial origin of vastus lateralis

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20
Q

Muscle attachment to posterior border of greater trochanter

A
  • ONLY border with NO muscular attachments

- Free rounded edge inferiorly, which blends with the intertrochanteric crest

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21
Q

Lesser trochanter

A
  • Located medially, near the junction of the femoral neck and shaft
  • Directed posteromedially
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22
Q

Muscle attachments for lesser trochanter (3)

A
  • Attachment site for iliopsoas muscle (ONLY attachment site for this muscle, which is a major flexor at the hip)
  • Psoas major inserts at the apex
  • Iliacus inserts at the base of the lesser trochanter, between the spiral and pectineal lines
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23
Q

Intertrochanteric line

A
  • Anterior line

- Located between greater and lesser trochanters at junction of neck and shaft

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24
Q

3 attachments to intertrochanteric line

A
  • Iliofemoral ligament (part of fibrous capsule of hip)
  • Vastus lateralis (partial origin)
  • Vastus medialis (partial origin)
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25
Q

Intertrochanteric crest

A
  • POSTERIOR crest
  • Located between greater and lesser trochanters
  • Hip joint capsule is NOT attached here
  • Contains quadrate tubercle
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26
Q

Quadrate tubercle

A
  • Located at mid-intertrochanteric area
  • Site of insertion of quadratus femoris
  • Sometimes quadrate line is present (instead of tubercle)
  • Quadrate tubercle/line extends vertically (straight up) 5 cm with the superior extent located along the intertrochanteric crest
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27
Q

Shaft of femur

A

3 borders

  • Medial
  • Lateral
  • Posterior

3 surfaces

  • Medial
  • Lateral
  • Anterior
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28
Q

Medial and lateral borders

A
  • Both borders are rough and poorly defined
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29
Q

Posterior border major feature

A

Linea aspera (“rough line”)

30
Q

Linea aspera

A
  • A crest that is located along the posterior border of the middle 1/3 of femur
  • This crest has 2 lips (medial and lateral lips) with a rough area in between (intermediate
  • Superiorly, 3 lines joint to form linea aspera
31
Q

3 lines that join to form linea aspera

A
  • Spiral line
  • Pectineal line
  • Lateral line
32
Q

Spiral line

A
  • Medial line from intertrochanter line

- Continuous with linea aspera

33
Q

Pectineal line

A
  • Intermediate line from lesser trochanter

- Continuous with medial lip

34
Q

Lateral line

A
  • Lateral line from greater trochanter
  • Continuous with lateral lip
  • Extends almost vertically
  • Gluteal tuberosity is located here for partial insertion of gluteus maximus which also inserts on the IT band
35
Q

Variation in gluteal tuberosity

A
  • Often times the proximal portion of the gluteal tuberosity is elongated and enlarged
  • It is then called the “third trochanter” or “gluteal trochanter”
36
Q

Inferior landmarks

A
  • Lateral lip and medial lip of linea aspera diverge as 2 ridges into the lateral and medial supracondylar ridges
37
Q

Lateral supracondylar ridge

A
  • More distinct

- Extends toward lateral epicondyle

38
Q

Medial supracondylar ridge

A
  • Ends at adductor tubercle
  • Smooth, just proximal to adductor hiatus
  • Adductor hiatus is where femoral vessels pass to popliteal fossa
39
Q

Popliteal surface

A
  • The two ridges (lateral and medial supracondylar ridges) form a triangular surface called the popliteal surface
40
Q

Anterior surface of shaft of femur

A
  • Smooth, convex surface
  • Lies between medial and lateral borders
  • Attachment site for 2 muscles
41
Q

2 muscles that attach to anterior surface of shaft of femur

A
  • Vastus intermedius (upper 2/3)

- Articularis genu

42
Q

Articularis genu

A
  • Femur may be roughened for several small slips of origin for this muscle
  • This is the distal attachment (anterior surface of shaft of femur)
43
Q

Distal extremity of femur

A
  • Major features include medial and lateral femoral condyles
44
Q

Lateral condyle

A
  • Broader, more pronounced than medial condyle
45
Q

Medial condyle

A
  • Longer, starts at adductor tubercle
46
Q

Femoral condyles (general)

A
  • Both condyles articulate with the posterior patella and respective condyles of the tibia
  • Both condyles are large, rounded, knob-like structures that project further posterior than anterior
47
Q

Lateral and medial sulci menisci

A
  • Groove (sulcus) located on each condyle

- This groove separates the patellar and tibial surfaces of the femoral condyles

48
Q

Lateral sulci menisci

A
  • Completely separates patellar surface of lateral femoral condyle from tibial surface
49
Q

Medial sulcus menisci

A
  • Deficient laterally (where tibial and patellar surfaces are continuous)
50
Q

Posterior surface of femur

A
  • Contains intercondylar notch

- Contains intercondylar line

51
Q

Intercondylar notch

A

AKA intercondylar fossa

- Separates femoral condyles posteriorly

52
Q

Intercondylar line

A
  • Serves as posterior boundary of notch

- Forms base of popliteal surface of femur

53
Q

Attachments to intercondylar line

A
  • ACL attaches posteriorly to the medial surface of the lateral condyle
  • PCL attaches anteriorly to lateral surface of medial condyle
  • Meniscofemoral ligametns
54
Q

Medial epicondyle

A
  • Lies above the medial condyle and just below the adductor tubercle
  • BOTH the adductor tubercle and medial epicondyle are palpable
55
Q

Attachments to medial epicondyle and adductor tubercle

A
  • Medial epicondyle is the attachment site for the tibial (medial) collateral ligament
  • Adductor tubercle is the attachment site for the tendon of adductor magnus muscle
  • Just posterior to the adductor tubercle is the attachment site for the gastrocnemius muscle
56
Q

Lateral epicondyle

A
  • Also palpable
  • Attachment site for fibular (lateral) collateral ligament
  • Lower portion has 2 grooves for the popliteus muscle
57
Q

Popliteus tendon

A

NOTE - the popliteus tendon changes position based on teh position of the knee (flexed or extended)

  • When the knee is FLEXED, the tendon is in the OBLIQUE groove
  • When the knee is EXTENDED, the tendon is in the vertical groove

REMEMBER: FO - EVer

  • Flexed = Oblique groove
  • Extended = Vertical groove
58
Q

Femoral arterial supply

A
  • Extensive blood supply for the largest bone in the body

- Proximal, shaft and distal supply

59
Q

Proximal supply

A

“FILM O femur”

  • F = first perforating artery (enters at neck)
  • I = inferior gluteal artery (enters at neck)
  • L = lateral femoral circumflex (enters at neck)
  • M = medial femoral circumflex (enters at neck)
  • O = obturator artery
60
Q

Medial femoral circumflex artery

A
  • Branch of profunda femoris

- Major supply to femoral head in adults

61
Q

Obturator artery

A
  • A branch of teh obturator artery courses within the ligament of the head of the femur
  • Supplies the femoral head
  • Important in infants, children and teens during ossification of the femur
  • Unimportant in adults because the medial femoral circumflex is the main supply
62
Q

Femoral shaft arterial supply

A
  • Nutrient artery from a branch of the second perforating artery
  • Nutrient canal is located posteriorly along the upper end of the linea aspera and is directed obliquely upward (away from growing end of bone during development)
  • NOTE: for ALL long bones, the nutrient canal is directed obliquely away from growth
63
Q

Distal femoral arterial supply

A
  • Superior lateral genicular artery
  • Superior medial genicular artery
  • Descending genicular artery
  • Descending branch of lateral femoral circumflex
64
Q

5 femoral ossification centers

A
  • Primary
  • 1st secondary
  • 2nd secondary
  • 3rd secondary
  • 4th secondary
65
Q

Primary femoral ossification center

A
  • Located at the shaft
  • Appears during the 7th fetal week
  • Fuses at puberty
66
Q

1st secondary femoral ossification center

A
  • Located at distal extremity
  • Appears around birth
  • Fuses at 16-18 years
67
Q

2nd secondary femoral ossification center

A
  • Located at head
  • Appears at 6 months
  • Fuses at 17 years
68
Q

3rd secondary femoral ossification center

A
  • Located at greater trochanter
  • Appears at 4 years
  • Fuses at 16 years
69
Q

4th secondary femoral ossification center

A
  • Located at lesser trochanter
  • Appears at 12-14 years
  • Fuses at 15 years
70
Q

Notes on ossification

A
  • The femur ossifies via endochondral ossification
  • The femur is the first bone to begin this type of ossification
  • The femur is the second earliest bone to ossify
  • Only the clavicle (which ossifies via an intramembranous method) begins to ossify earlier than the femur
  • The appearance and fusion times for each secondary center are inversely related - the later it appears, the sooner it fuses

Lower Limb (24 decks)

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