lower limb

Question 1

The bony pelvis: hip bone, sacrum and coccyx.

Answer 1

• Composed of three bones: the ilium, the ischium and the pubic. All 3 synostoses forming
  the acetabular fossa which plays a rule further on in the hip joint along with the acetabular
  labrum.
• The acetabular fossa is surrounded by the acetabular labrum and the lunate surface
  superiorly while inferiorly it opens through the acetabular notch to the obturator foramen.

The sacrum:
Lies between the fifth segment of the lumbar spine (L5) and the coccyx (tailbone), it is the
ossification of the 5 sacral vertebra bones.

The coccyx:
The final segment of the vertebral column (fused vertebras) , bordered by the apex and
coccygeal fossa

Question 2

The structure and diameters of the bony pelvis.

Answer 2

The bony pelvis is divided to the greater (false) pelvis and the lesser (true) pelvis, which are
separated by the terminal line.

The terminal line is a line going through the following structures:
1. sacral promontory
2. sacral wings
3. arcuate line
4. iliopubic eminence
5. iliopubic crest
6. symphysis.

Question 3

The joints and ligaments of the pelvis. The statics and radiological
anatomy of the pelvis.

Answer 3

Sacroiliac joint: an atypical synovial plane joint, contains fibrocartilage and has a very
limited range of movement.
Articular surfaces are the auricular surfaces of the ilium and sacrum.
It is stabilized by the interosseous ligaments and by the anterior & posterior sacroiliac
ligaments.

Pubic symphysis: the synchondrosis joint that unites the pubic bones in a secondary
cartilaginous articulation.
Contains a fibrocartilaginous disc and is reinforced by the superior and inferior pubic
ligaments.
Articular surfaces are the two symphyseal surfaces of the pubic bones.

Ligaments are found at the lumbosacral joint, sacroiliac joint, and pubic
symphysis
I. Lumbosacral joint
① Iliolumbar ligament
② Lumbosacral ligament

II. Sacroiliac joint
③ Anterior sacroiliac ligament
④ Interosseous sacroiliac ligament
⑤ Posterior sacroiliac ligament

III. Pubic symphysis
⑥ Superior pubic ligament
⑦ Arquate (Inferior) pubic ligament

Proper ligaments
⑧ Sacrospinous ligaments
⑨ Sacrotuberous ligaments
⑩ Obturator membrane
⑪ Inguinal ligament (POUPART)
⑫ Transverse acetabular ligament

・The sacrospinous and sacrotuberous ligaments are major components of the
lateral pelvic walls that help define the apertures between the pelvic cavity and
adjacent regions through which structures pass.

Question 4

The hip joint: gross and radiological anatomy, movements and the participating
muscles.

Answer 4

Hip joint: Type: Ball and socket synovial joint.
Articular facets: Acetabulum of the hip bone(lunate surface) and head of femur.
Ligaments: intracapsular, transverse acetabular ligament.
2. Lig. Of head of the femur ( <- artery of ligament of head <- acetabular branch
of obturator artery)
2. extracapsular:
1. iliofemoral lig.,
2. pubofemoral lig(obturator crest, superior ramus of pubis to joint capsule)
3. ischiofemoral lig.(ligament of Bertin – ischium to joint capsule).
Movements: flexion/(anteflexion) 60°, extension(retroflexion) 5-15°,abduction,adduction,
rotation(construction axis of lower limb), circumduction.

Muscles participating in movement of hip joint:
1. Gluteal group: gluteus maximus, medius, minimus, tensor fasciae latae.
2. Adductor group: adductor brevis, longus, magnus, pectineus and gracilis.
3. Iliopsoas group: iliacus and psoas major.
4. Lateral rotator group: obturator internus, externus, piriformis, superior & inferior
gemelli, and quadrates femoris.

Question 5

The femur, tibia, fibula. Connections between tibia and fibula.

Answer 5

Connections between tibia and fibula:
Superior tibiofibular joint: - - -
plane joint, true synovial joint
Articular surfaces: posterior surface of lateral condyle of tibia and head of fibula.
Ligaments:
1) anterior ligament of fibular head
2) Posterior ligament of fibular head
Syndesmosis tibiofibular (distal tibiofibular joint) - -
Syndesmosis
Ligaments: 1) Anterior tibiofibular ligament
2) Posterior tibiofibular ligament
3) Interosseous ligament

Question 6

The knee joint: gross and radiological anatomy, movements and participating muscles.

Answer 6

Type: condylar, “trochoginglymus” (troch: pivot, ginglymus: hinge) - (synovial joint)
Articular facets:
Condyles of femur
femorotibial joint, hinge joint
Patellar surface of
the femur
femoropatellar joint, saddle joint
*fibula is not included in the knee joint

Ligaments:
intracapsular:
1) Anterior cruciate ligament.
2) Posterior cruciate ligament.
3) transverse ligament of knee
Extracapsular:
1) tibial / medial collateral ligament
2) fibular / lateral collateral ligament
3) patellar ligament
4) med. & lat. patellar retinacula
5) oblique popliteal ligament
6) Arcuate popliteal ligament

Participating muscles:
* Quadriceps femoris(rectus femoris and vastus medialis, lateralis,intermedius)→
extension of knee joint
* Gracilis along With the tendons of sartorius and semitendinosus) → flexion and
internal rotation of knee joint.

Question 6

The ankle (talocrural) joint: gross and radiological anatomy,
movements and participating muscles.

Answer 6

Type: hinge (ginglymus) Synovial
Articular facets:
trochlea of the talus
⇕
inf. articular surface of the tibia + tibial and fibular malleolus
Synovial membrane
The joint is lined by a synovial membrane which projects into the distal tibiofibular joint.
Ligaments: 2 groups
1. deltoid (or medial / tibial collateral) lig. - anterior tibiotalar lig. - posterior tibiotalar lig. - tibiocalcanean lig. →inserts in the sustentaculum tali - tibionavicular lig

2. lateral / fibular collateral lig. - anterior talofibular lig. - posterior talofibular lig. - calcaneofibular lig.

dorsiflexion: Tibialis anterior, Extensor digitorum longus, Extensor hallucis longus, Fibularis tertius

planter flexion: Fibularis longus, Fibularis brevis, Triceps surae, Tibialis posterior, Flexor digitorum longus, Flexor hallucis longus

Question 6

Anatomy of the intertarsal joints and surgical lines of the foot. Movements of the foot: participating muscles.

Answer 6

Intertarsal joints
1. Subtalar joint = Posterior talocalcanean joint
Articular facets
: Posterior talar articular surface ⇔ Posterior calcaneal articular surface
Type of joint
Additional component
ligaments
Movements
: Synovial joint → Pivot joint
: ———-
: Lateral talocalcanean ligament
Medial talocalcanean ligament
Interosseous talocalcanean ligament (lies in the sinus tarsi)
Posterior talocalcanean ligament
: Inversion ⇔ Eversion
2. Talocalcaneonavicular joint
Articular facets
: between talus and navicular bone
Talar articular surface of navicular bone ⇔ Navicular articular surface
Between talus and calcaneus
(Anterior)
Anterior talar articular surface ⇔ Anterior calcaneal articular surface
(Middle)
Middle talar articular surface ⇔ Middle calcaneal articular surface
Type of joint
Additional component
ligaments
Movements
: Synovial joint → Boll-and-socket joint
: ———-
: Talonavicular ligament
Plantar calcaneonavicular ligament = spring ligament
: Inversion ⇔ Eversion

Question 7

The anatomy of the foot arches. Radiological anatomy of the foot.

Answer 7

Medial arch:
The medial arch is the higher of the two longitudinal
arches. It is formed by the calcaneus, talus, navicular,
three cuneiforms and first three metatarsal bones. It
is supported by:
* Muscular support: Tibialis anterior and posterior,
fibularis longus, flexor digitorum longus, flexor
hallucis, and the intrinsic foot muscles
* Ligamentous support: Plantar ligaments (in
particular the long plantar, short plantar and
plantar calcaneonavicular ligaments), medial
ligament of the ankle joint.
* Bony support: Shape of the bones of the arch.

lateral arch:
The lateral arch is the flatter of the two longitudinal
arches, and lies on the ground in the standing
position. It is formed by the calcaneus, cuboid and
4th and 5th metatarsal bones. It is supported by:
* Muscular support: Fibularis longus, flexor digitorum longus, flexor hallucis, and the intrinsic
foot muscles.
* Ligamentous support: Plantar ligaments (in particular the long plantar, short plantar and
plantar calcaneonavicular ligaments).
* Bony support: Shape of the bones of the arch

Transverse arch:
・sustentaculum tali
・long plantar ligament
・plantar calcaneonavicular ligament (spring ligament)
・plantar aponeurosis
・plantar muscles
The transverse arch is located in the coronal plane of the foot. It is formed by the metatarsal
bases, the cuboid and the three cuneiform bones. It has:
* Muscular support: Fibularis longus and tibialis posterior.
* Ligamentous support: Plantar ligaments (in particular the long plantar, short plantar and
plantar calcaneonavicular ligaments) and deep transverse metatarsal ligaments.
* Other support: Plantar aponeurosis.
* Bony support: The wedged shape of the bones of the arch.

Question 8

Arteries of the lower limb, anastomoses between the branches of the
femoral artery.