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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
Intertrochanteric crest
- POSTERIOR crest - Located between greater and lesser trochanters - Hip joint capsule is NOT attached here - Contains quadrate tubercle
26
Quadrate tubercle
- 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
27
Shaft of femur
3 borders - Medial - Lateral - Posterior 3 surfaces - Medial - Lateral - Anterior
28
Medial and lateral borders
- Both borders are rough and poorly defined
29
Posterior border major feature
Linea aspera ("rough line")
30
Linea aspera
- 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
3 lines that join to form linea aspera
- Spiral line - Pectineal line - Lateral line
32
Spiral line
- Medial line from intertrochanter line | - Continuous with linea aspera
33
Pectineal line
- Intermediate line from lesser trochanter | - Continuous with medial lip
34
Lateral line
- 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
Variation in gluteal tuberosity
- Often times the proximal portion of the gluteal tuberosity is elongated and enlarged - It is then called the "third trochanter" or "gluteal trochanter"
36
Inferior landmarks
- Lateral lip and medial lip of linea aspera diverge as 2 ridges into the lateral and medial supracondylar ridges
37
Lateral supracondylar ridge
- More distinct | - Extends toward lateral epicondyle
38
Medial supracondylar ridge
- Ends at adductor tubercle - Smooth, just proximal to adductor hiatus - Adductor hiatus is where femoral vessels pass to popliteal fossa
39
Popliteal surface
- The two ridges (lateral and medial supracondylar ridges) form a triangular surface called the popliteal surface
40
Anterior surface of shaft of femur
- Smooth, convex surface - Lies between medial and lateral borders - Attachment site for 2 muscles
41
2 muscles that attach to anterior surface of shaft of femur
- Vastus intermedius (upper 2/3) | - Articularis genu
42
Articularis genu
- 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
Distal extremity of femur
- Major features include medial and lateral femoral condyles
44
Lateral condyle
- Broader, more pronounced than medial condyle
45
Medial condyle
- Longer, starts at adductor tubercle
46
Femoral condyles (general)
- 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
Lateral and medial sulci menisci
- Groove (sulcus) located on each condyle | - This groove separates the patellar and tibial surfaces of the femoral condyles
48
Lateral sulci menisci
- Completely separates patellar surface of lateral femoral condyle from tibial surface
49
Medial sulcus menisci
- Deficient laterally (where tibial and patellar surfaces are continuous)
50
Posterior surface of femur
- Contains intercondylar notch | - Contains intercondylar line
51
Intercondylar notch
AKA intercondylar fossa | - Separates femoral condyles posteriorly
52
Intercondylar line
- Serves as posterior boundary of notch | - Forms base of popliteal surface of femur
53
Attachments to intercondylar line
- ACL attaches posteriorly to the medial surface of the lateral condyle - PCL attaches anteriorly to lateral surface of medial condyle - Meniscofemoral ligametns
54
Medial epicondyle
- Lies above the medial condyle and just below the adductor tubercle - BOTH the adductor tubercle and medial epicondyle are palpable
55
Attachments to medial epicondyle and adductor tubercle
- 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
Lateral epicondyle
- Also palpable - Attachment site for fibular (lateral) collateral ligament - Lower portion has 2 grooves for the popliteus muscle
57
Popliteus tendon
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
Femoral arterial supply
- Extensive blood supply for the largest bone in the body | - Proximal, shaft and distal supply
59
Proximal supply
"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
Medial femoral circumflex artery
- Branch of profunda femoris | - Major supply to femoral head in adults
61
Obturator artery
- 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
Femoral shaft arterial supply
- 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
Distal femoral arterial supply
- Superior lateral genicular artery - Superior medial genicular artery - Descending genicular artery - Descending branch of lateral femoral circumflex
64
5 femoral ossification centers
- Primary - 1st secondary - 2nd secondary - 3rd secondary - 4th secondary
65
Primary femoral ossification center
- Located at the shaft - Appears during the 7th fetal week - Fuses at puberty
66
1st secondary femoral ossification center
- Located at distal extremity - Appears around birth - Fuses at 16-18 years
67
2nd secondary femoral ossification center
- Located at head - Appears at 6 months - Fuses at 17 years
68
3rd secondary femoral ossification center
- Located at greater trochanter - Appears at 4 years - Fuses at 16 years
69
4th secondary femoral ossification center
- Located at lesser trochanter - Appears at 12-14 years - Fuses at 15 years
70
Notes on ossification
- 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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