L5: Appendicular Pt. 2 Flashcards
What is the general structure of the female pelvis?
Light and thin
What is the general structure of the male pelvis?
Heavy and thick
What is the greater (false) pelvis like in females?
Shallow
What is the greater (false) pelvis like in males?
Deep
What is the shape of the pelvic inlet in females?
Wide and more oval
What is the shape of the pelvic inlet in males?
Narrow and heart-shaped
What is the size and orientation of the acetabulum in females?
Small and faces anteriorly
What is the size and orientation of the acetabulum in males?
Large and faces laterally
What is the shape of the obturator foramen in females?
Oval
What is the shape of the obturator foramen in males?
Round
What is the pubic arch angle in females?
Greater than 90° angle
What is the pubic arch angle in males?
Less than 90° angle
How is the iliac crest shaped in females?
Less curved
How is the iliac crest shaped in males?
More curved
How is the ilium oriented in females?
Less vertical
How is the ilium oriented in males?
More vertical
What is the greater sciatic notch like in females?
Wide (almost 90°)
What is the greater sciatic notch like in males?
Narrow (about 70°; inverted V)
How is the sacrum shaped in females?
Shorter, wider, and less curved anteriorly
How is the sacrum shaped in males?
Longer, narrower, and more curved anteriorly
What is the femur also known as?
Thigh bone
What is the longest, heaviest, and strongest bone in the body?
Femur
What does the proximal end of the femur articulate with?
Acetabulum of the hip bone
What does the distal end of the femur articulate with?
Tibia and patella
Why are the knee joints closer to the midline than the hip joints?
Because the body of the femur angles medially
Why is the angle of convergence greater in females?
Because the female pelvis is broader
What is the rounded head of the femur’s function?
It articulates with the acetabulum of the hip bone to form the hip joint
What is the small central depression in the head of the femur called?
Fovea for ligament of head of femur or fovea capitis
What does the ligament of the head of the femur connect?
The fovea of the femur to the acetabulum of the hip bone
What is the constricted region distal to the head of the femur called?
Neck of the femur
A broken hip is more often associated with a fracture in which part?
Neck of the femur
What are the greater trochanter and lesser trochanter?
Projections from the junction of the neck and body of the femur that serve as attachment points for tendons of thigh and buttock muscles
Where is the greater trochanter located?
Anterior to the hollow on the side of the hip
What is a common landmark for intramuscular injections into the lateral surface of the thigh?
Greater trochanter
Where is the lesser trochanter located?
Inferior and medial to the greater trochanter
What is the narrow line between the anterior surfaces of the trochanters called?
Intertrochanteric line
What is the ridge between the posterior surfaces of the trochanters called?
Intertrochanteric crest
What is the vertical ridge inferior to the intertrochanteric crest called?
Gluteal tuberosity
What is the vertical ridge that the gluteal tuberosity blends into called?
Linea aspera
What is the function of the gluteal tuberosity and linea aspera?
Attachment points for tendons of several thigh muscles
What are the expanded distal ends of the femur called?
Medial condyle and lateral condyle
What do the medial and lateral condyles of the femur articulate with?
Medial and lateral condyles of the tibia
What structures are superior to the condyles and attach ligaments of the knee joint?
Medial epicondyle and lateral epicondyle
What is the depressed area between the condyles on the posterior surface called?
Intercondylar fossa
Where is the patellar surface located?
Between the condyles on the anterior surface
What is the roughened projection just superior to the medial epicondyle?
Adductor tubercle
What muscle attaches to the adductor tubercle?
Adductor magnus muscle
What is the pelvic outlet of the female?
wider
What is the pelvic outlet of the male?
narrower
What is the ischial tuberosity of the female?
Shorter, farther apart, and more medially projecting.
What is the ischial tuberosity of the male?
Longer, closer together, and more laterally projecting.
What is the patella also known as?
Kneecap
What is the shape of the patella?
Small, triangular
Where is the patella located?
Anterior to the knee joint
What type of bone is the patella?
Sesamoid bone
In which muscle tendon does the patella develop?
Quadriceps femoris muscle
What is the broad proximal end of the patella called?
Base
What is the pointed distal end of the patella called?
Apex
What does the posterior surface of the patella contain?
Two articular facets
What do the articular facets of the patella articulate with?
Medial condyle and lateral condyle of the femur
What attaches the patella to the tibial tuberosity?
Patellar ligament
What is the patellofemoral joint?
The joint between the posterior surface of the patella and the patellar surface of the femur
What is the intermediate component of the tibiofemoral (knee) joint?
Patellofemoral joint
What are the three functions of the patella?
Increases leverage of the tendon of the quadriceps femoris muscle, maintains tendon position when the knee is bent (flexed), and protects the knee joint
What is patellofemoral stress syndrome also known as?
Runner’s knee
What is one of the most common problems runners experience?
Patellofemoral stress syndrome (runner’s knee)
How does the patella normally track during flexion and extension of the knee?
Superiorly and inferiorly in the groove between the femoral condyles
What happens to patella tracking in patellofemoral stress syndrome?
The patella tracks laterally as well as superiorly and inferiorly
What does the increased pressure on the joint cause in patellofemoral stress syndrome?
Aching or tenderness around or under the patella
When does pain typically occur in patellofemoral stress syndrome?
After sitting for a while, especially after exercise
What activities worsen the pain of patellofemoral stress syndrome?
Squatting or walking down stairs
What is one cause of runner’s knee?
Constantly walking, running, or jogging on the same side of the road
What are some predisposing factors for patellofemoral stress syndrome?
Muscle weakness, vigorous physical activities that stress the knee, running on hills, running long distances, and genu valgum (knock-knee)
What is the anatomical deformity associated with patellofemoral stress syndrome?
Genu valgum (knock-knee)
What are some treatment options for patellofemoral stress syndrome?
Decreasing activities that worsen the condition, ice, anti-inflammatory medications (such as ibuprofen), kinesiology tape or knee braces, custom orthotics, physical therapy, and arthroscopy
articulate to form the hip joint
acetabulum of the hip bone and head of the femur
What is another name for the tibia?
Shin bone
What is the larger, medial, weight-bearing bone of the leg?
Tibia
What does the term tibia mean?
Flute
Why was the tibia called a flute?
Because the tibial bones of birds were used in ancient times to make musical instruments
What bones does the tibia articulate with at its proximal end?
Femur and fibula
What bones does the tibia articulate with at its distal end?
Fibula and talus bone of the ankle
What connects the tibia and fibula, like the ulna and radius?
Interosseous membrane
What is the proximal end of the tibia expanded into?
Lateral condyle and medial condyle
What do the lateral and medial condyles of the tibia articulate with?
Condyles of the femur
What do the lateral and medial condyles of the tibia form?
Lateral and medial articular surfaces of the knee joints
What does the inferior surface of the lateral condyle of the tibia articulate with?
Head of the fibula
What is the upward projection that separates the slightly concave condyles?
Intercondylar eminence
What is the tibial tuberosity?
A point of attachment for the patellar ligament
What is the sharp ridge below the tibial tuberosity that can be felt under the skin?
Anterior border (crest) or shin
What does the medial surface of the distal end of the tibia form?
Medial malleolus
What does the medial malleolus articulate with?
Talus of the ankle
What is the prominence that can be felt on the medial surface of the ankle region?
Medial malleolus
What does the fibular notch articulate with?
Distal end of the fibula
What joint does the fibular notch help form?
Distal tibiofibular joint
Which long bone of the body is most frequently fractured?
Tibia
What is the most frequent site of an open (compound) fracture?
Tibia
What bone is parallel and lateral to the tibia?
Fibula
How does the size of the fibula compare to the tibia?
It is considerably smaller
Does the fibula articulate with the femur?
No
What does the fibula help stabilize?
Ankle joint
What is the proximal end of the fibula called?
Head of the fibula
What does the head of the fibula articulate with?
Inferior surface of the lateral condyle of the tibia
What joint does the head of the fibula help form?
Proximal tibiofibular joint
What is the distal end of the fibula shaped like?
Arrowhead
What is the projection on the distal end of the fibula called?
Lateral malleolus
What does the lateral malleolus articulate with?
Talus of the ankle
What does the lateral malleolus form on the ankle region?
The prominence on the lateral surface
Where does the fibula articulate with the tibia to form the distal tibiofibular joint?
Fibular notch
articulates with the lateral and medial condyles of the femur.
patella
articulates with the femur and fibula proximally, and with the fibula and talus distally.
tibia
MNEMONIC for location of tibia and fibula:
The fibuLA is LAteral.
What does bone grafting generally consist of?
Taking a piece of bone, along with its periosteum and nutrient artery, from one part of the body to replace missing bone in another part of the body
What does the transplanted bone restore?
The blood supply to the transplanted site
How does healing occur after bone grafting?
As in a fracture
What is a common source of bone for grafting?
Fibula
Why is the fibula commonly used for bone grafting?
Because even after a piece of the fibula has been removed, walking, running, and jumping can be normal
What is the weight-bearing bone of the leg?
Tibia
What is the proximal region of the foot called?
Tarsus (ankle)
How many tarsal bones are in the foot?
Seven
What are the two tarsal bones located in the posterior part of the foot?
Talus and calcaneus
What is the largest and strongest tarsal bone?
Calcaneus
What are the anterior tarsal bones?
Navicular, medial (first) cuneiform, intermediate (second) cuneiform, lateral (third) cuneiform, and cuboid
What are the joints between tarsal bones called?
Intertarsal joints
What is the most superior tarsal bone?
Talus
What is the only bone of the foot that articulates with the fibula and tibia?
Talus
What are the two structures that articulate with the talus?
Medial malleolus of the tibia and lateral malleolus of the fibula
What joint is formed by the articulation of the talus with the tibia and fibula?
Ankle (talocrural) joint
During walking, which bone transmits about half the weight of the body to the calcaneus?
Talus
What region of the foot is called the metatarsus?
The intermediate region of the foot
How many metatarsal bones are in the foot?
Five
How are the metatarsal bones numbered?
1–5 from medial to lateral
What are the three parts of each metatarsal bone?
Proximal base, intermediate body, and distal head
What bones do the metatarsals articulate with proximally?
First, second, and third cuneiform bones and the cuboid
What joints are formed between the metatarsals and the cuneiform/cuboid bones?
Tarsometatarsal joints
What bones do the metatarsals articulate with distally?
Proximal row of phalanges
What joints are formed between the metatarsals and phalanges?
Metatarsophalangeal joints
Which metatarsal is thicker than the others because it bears more weight?
First metatarsal
What is the distal component of the foot?
Phalanges
How are the toes numbered?
1–5, beginning with the great toe from medial to lateral
What are the three parts of each phalanx?
Proximal base, intermediate body, and distal head
What is another name for the great toe?
Hallux
How many phalanges does the great toe have?
Two (proximal and distal phalanges)
How many phalanges do toes 2–5 have?
Three (proximal, middle, and distal phalanges)
What do the proximal phalanges of all toes articulate with?
Metatarsal bones
What do the middle phalanges of toes 2–5 articulate with?
Their distal phalanges
What does the proximal phalanx of the great toe articulate with?
Its distal phalanx
What are the joints between the phalanges of the foot called?
Interphalangeal joints
When do fractures of the metatarsals occur?
When a heavy object falls onto or rolls over the foot
Among whom are metatarsal fractures common?
Dancers, especially ballet dancers
What happens if a ballet dancer is on the tip of her toes and loses her balance?
The full body weight is placed on the metatarsals, causing one or more of them to fracture
How are the bones of the foot arranged?
In two arches that are held in position by ligaments and tendons
What do the arches of the foot enable?
They enable the foot to support the weight of the body, provide an ideal distribution of body weight over the soft and hard tissues of the foot, and provide leverage while walking
How do the arches of the foot function when weight is applied and lifted?
They yield as weight is applied and spring back when the weight is lifted, storing energy for the next step and helping to absorb shocks
By what age are the arches of the foot fully developed?
By age 12 or 13
What are the two parts of the longitudinal arch?
The medial part and the lateral part
Where does the medial part of the longitudinal arch originate?
At the calcaneus
Through which bones does the medial part of the longitudinal arch rise and descend?
It rises to the talus and descends through the navicular, the three cuneiforms, and the heads of the three medial metatarsals
Where does the lateral part of the longitudinal arch begin?
At the calcaneus
How does the lateral part of the longitudinal arch rise and descend?
It rises at the cuboid and descends to the heads of the two lateral metatarsals
Why does the medial portion of the longitudinal arch not touch the ground when walking on a hard surface?
Because the medial portion of the arch is so high
Where is the transverse arch found?
Between the medial and lateral aspects of the foot
Which bones form the transverse arch?
The navicular, three cuneiforms, and the bases of the five metatarsals
What is one function of the arches?
To distribute body weight over the soft and hard tissues of the body
How is body weight normally distributed between the ball of the foot and the heel?
The ball of the foot carries about 40% of the weight, and the heel carries about 60%
What is the ball of the foot?
The padded portion of the sole superficial to the heads of the metatarsals
How does wearing high-heeled shoes change weight distribution?
The ball of the foot may carry up to 80% of the weight, while the heel carries only 20%
What problems can result from wearing high-heeled shoes?
The fat pads at the ball of the foot are damaged, joint pain develops, and structural changes in bones may occur
The skeleton of the foot consists of the
proximal tarsals, the intermediate metatarsals, and the distal phalanges.
MNEMONIC for tarsals:
Tall Centers Never Take Shots From Corners. Talus Calcaneus Navicular Third cuneiform Second cuneiform First cuneiform Cuboid
help the foot support and distribute the weight of the body and provide leverage during walking.
Arches
What holds the bones composing the arches of the foot in position?
Ligaments and tendons
What happens if the ligaments and tendons of the foot are weakened?
The height of the medial longitudinal arch may decrease or “fall”
What is the result of a fallen medial longitudinal arch?
Flatfoot
What are the causes of flatfoot?
Excessive weight, postural abnormalities, weakened supporting tissues, and genetic predisposition
What conditions can fallen arches lead to?
Inflammation of the fascia of the sole (plantar fasciitis), Achilles tendinitis, shin splints, stress fractures, bunions, and calluses
What is often prescribed to treat flatfoot?
A custom-designed arch support
What is clawfoot?
A condition in which the medial longitudinal arch is abnormally elevated
What often causes clawfoot?
Muscle deformities
In which individuals may muscle deformities leading to clawfoot occur?
Diabetics whose neurological lesions lead to atrophy of muscles of the foot
What develops after the limb buds?
endochondral ossification of the limb bones begins by the end of the eighth embryonic week
What do most skeletal tissues arise from?
Mesenchymal cells
What are mesenchymal cells derived from?
Mesoderm
What part of the skeleton arises from ectoderm?
Much of the skeleton of the skull
What do mesenchymal cells condense and form?
Models of bones
Where do bones form directly within mesenchyme?
Intramembranous ossification
Where do bones form within hyaline cartilage that develops from mesenchyme?
Endochondral ossification
When does the skull begin development?
During the fourth week after fertilization
From what does the skull develop?
Mesenchyme around the developing brain
What are the two major portions of the skull?
Neurocranium and viscerocranium
What is the origin of the neurocranium?
Mesodermal
What does the neurocranium form?
The cranial cavity bones
What is the origin of the viscerocranium?
Ectodermal
What does the viscerocranium form?
Facial bones
What are the two parts of the neurocranium?
Cartilaginous neurocranium and membranous neurocranium
What does the cartilaginous neurocranium consist of?
Hyaline cartilage developed from mesenchyme at the cranial base
What does the cartilaginous neurocranium later undergo?
Endochondral ossification
What does endochondral ossification form in the neurocranium?
Bones of the cranial base
What does the membranous neurocranium consist of?
Mesenchyme
What does the membranous neurocranium later undergo?
Intramembranous ossification
What does intramembranous ossification form in the neurocranium?
The flat bones that make up the roof and sides of the skull
What are the membrane-filled spaces that separate the flat bones during fetal life and infancy?
Fontanels
What are the two parts of the viscerocranium?
Cartilaginous viscerocranium and membranous viscerocranium
From where is the cartilaginous viscerocranium derived?
The cartilage of the first two pharyngeal arches
What does endochondral ossification of the cartilaginous viscerocranium form?
Portions of the jaw bones, ear bones, and hyoid bone
From where is the membranous viscerocranium derived?
Mesenchyme in the first pharyngeal arch
What does intramembranous ossification of the membranous viscerocranium form?
Facial bones
From what are vertebrae and ribs derived?
Portions of cube-shaped masses of mesoderm called somites
When do mesenchymal cells from somites surround the notochord?
About 4 weeks after fertilization
What is the notochord?
A solid cylinder of mesodermal cells
What does the notochord induce mesenchymal cells to form?
Vertebral bodies, costal (rib) centers, and vertebral arch centers
What does the notochord induce mesenchymal cells between vertebral bodies to form?
The nucleus pulposus of an intervertebral disc
What do surrounding mesenchymal cells form in the intervertebral disc?
The annulus fibrosus
What happens if the vertebral arch does not develop properly?
A condition called spina bifida
From where do the ribs develop?
Processes from the vertebrae
From where does the sternum develop?
Mesoderm in the anterior body wall
From where is the skeleton of the girdles and limbs derived?
Mesoderm
When do upper limb buds appear?
During the middle of the fourth week after fertilization
When do lower limb buds appear?
About 2 days after the upper limb buds
What do limb buds consist of?
Mesenchyme covered by ectoderm
What will some of the mesoderm surrounding the developing bones become?
Skeletal muscles of the limbs
When do the limb buds develop a constriction around the middle portion?
By the sixth week
What does the constriction in the upper limb bud produce?
Hand plates
What does the constriction in the lower limb bud produce?
Foot plates
What do hand plates and foot plates represent?
The beginnings of the hands and feet
What type of skeleton is present in the limbs at this stage?
A cartilaginous skeleton formed from mesenchyme
When do the arm, forearm, and hand become evident in the upper limb bud?
By the seventh week
When do the thigh, leg, and foot appear in the lower limb bud?
By the seventh week
When do the shoulder, elbow, and wrist areas become apparent?
By the eighth week
What are the limb buds called by the eighth week?
The upper limb and the lower limb
When does endochondral ossification of the limb bones begin?
By the end of the eighth week after fertilization
When are primary ossification centers present in most limb bones?
By the twelfth week
When do most secondary ossification centers appear?
After birth
What does the term hip fracture refer to?
A break in the proximal end of the femur (head, neck, and trochanteric regions)
What bones may a hip fracture also involve?
The bones that form the acetabulum
In which age group do the majority of hip fractures occur?
Individuals older than 60
How does the frequency of hip fractures change beyond age 60?
It increases even more
What is the estimated incidence of hip fractures in the United States per year?
Between 300,000 to 500,000
What is the most common cause of a hip fracture in the elderly?
A fall
What are causes of hip fractures in younger people?
Automobile accidents, falls from significant heights, or severe trauma
What are complications of hip fractures?
Blood clots, pneumonia, muscle atrophy (decrease in muscle mass), postoperative infection, and bedsores
What condition predisposes elderly people to hip fractures?
Decreases in bone mass due to osteoporosis
In which group does osteoporosis occur more often?
Females
What are other contributing factors to hip fractures?
Lack of physical activity, low body weight, inadequate calcium and vitamin D intake, excessive alcohol consumption, cigarette smoking, vision problems, and dementia
What treatment do hip fractures often require?
Surgical treatment
What is the goal of surgical treatment for hip fractures?
To repair and stabilize the fracture, increase mobility, and decrease pain
How is the repair of a hip fracture sometimes accomplished?
By using surgical pins, screws, nails, and plates to secure the head of the femur
What may be replaced in severe hip fractures?
The femoral head or the acetabulum of the hip bone
What are the prostheses used to replace the femoral head or acetabulum called?
Artificial devices
What is hemiarthroplasty?
The procedure of replacing either the femoral head or the acetabulum
What is the meaning of “hemiarthroplasty” based on its word parts?
Hemi- = one-half, -arthro- = joint, -plasty = molding
What is total hip arthroplasty?
The replacement of both the femoral head and acetabulum
What material is the acetabular prosthesis made of?
Plastic
What material is the femoral prosthesis made of?
Metal
What are the prostheses designed to withstand?
A high degree of stress
How are the prostheses attached to healthy portions of bone?
With acrylic cement and screws
An inherited deformity in which the foot is twisted inferiorly and medially, and the angle of the arch is increased; occurs in 1 of every 1000 births. Treatment consists of manipulating the arch to a normal curvature by casts or adhesive tape, usually soon after birth. Corrective shoes or surgery may also be required.
Clubfoot or talipes equinovarus
A deformity in which the knees are abnormally close together and the space between the ankles is increased due to a lateral angu lation of the tibia in relation to the femur. Also called knock-knee.
Genu valgum
A deformity in which the knees are abnormally separated, there is a medial angulation of the tibia in relation to the femur, and the lower limbs are bowed laterally. Also called bowleg.
Genu varum
Angulation of the great toe away from the midline of the body, typically caused by wearing tightly fitting shoes. When the great toe angles toward the next toe, there is a bony protrusion at the base of the great toe. Also called a bunion.
hallux valgus
