PELVIS

Slide 1-2

Special thanks to:

Adalia ain

Aina syahirah

Faten nur ezzati

Aisyah KZ

Kauthar

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‫بسم هللا الرحمن الرحيم‬

Pelvis consists of bones, muscles, fascia, ligaments and joints. It’s also
contents the nerves, blood vessels, lymphatic vessels and the pelvic
organs.

Pelvis bones consist of 2 hip bones, sacrum and coccyx. I’ll talk about
the bone. After that I will show you the diagram. Each hip bone
consists of 3 bones. These 3 bones unite together at the acetabulum.
And there are ileum, ischium and pubis. Between the pubis anteriorly
and ischium posteriorly there is the gap and this gap is called obturator
foramen(open). As I told you the hip bone consist of 3 bones. Ileum lies
above and two bones lies inferiorly. One of them lies anterior and the
other posterior. And there is a gap between these two inferior bones.
This gap is called obturator foramen. Do you know what the means of
foramen? It’s an opening.

Feature Of Each Bone.

Features of ileum. The ileum has the apparent criteria.

The first one, iliac forming crest. What the meaning of crest? What
are the differences between crest and tubercle? (Refer the picture)

#crest = margin #tubercle = end of the margin(lies at

the end of crest)

Then the iliac crest to the anterior iliac spine. What is the meaning of
spine? It is the spinous process.

Have anterior superior iliac spine, anterior inferior iliac spine,

posterior superior iliac spine, posterior inferior iliac spine and greater
sciatic notch.

There are 2 surfaces: medial surface and lateral surface.

Medial surface within the ileum. There are iliac fossa (fossa means
shallow depression while the notch is deep depression) lies on the
medial surface of ileum. Then you have iliac tuberosity, auricular
surface, and arcuate line. Arcuate means arch.

Lateral surface of the ileum are the 3 lines. These lines are called the
posterior, anterior & inferior. (gluteal line). These line lies at the
lateral surface of the ileum.
Features of ischium. Ischium has body, the main part of the bone.
Then we have inferior ramus (branch the limb???Sorry. I’m not sure),
ischial spine, lesser sciatic notch and ischial tuberosity.

Features of pubic bone or pubis. Consist of body, superior ramus,

inferior ramus, pubic crest (margin), pubic
tubercle (end of margin), and we have
ileopectineal line.

Dr is referring to the pelvic girdle picture. This

is the pelvic bone of the pelvis. Consist of 2 hip
bone unite anteriorly together but posteriorly
they unite to the sacrum. So consist of 2 hip bone, sacrum and coccyx.

Now the dr is explaining the picture of

medial surface of the ileum. Please refer to
the picture. This is the iliac crest (at the
top). Then all the 4 types of spine. Anterior
superior iliac spine and anterior inferior
iliac spine is at the left side of the picture
which is at the anterior view. While the
posterior superior iliac spine and posterior
inferior iliac spine is at the right side of the
figure which is at the posterior view. Then
this is the greater sciatic notch. This is
arcuate line (the medial surface of the ilium is divided into two parts
by arcuate line) and the ileopectineal line (runs downward and forward
around the inner surface of the ilium).

And the pubis we have the body of pubis, pubic tubercle, superior
ramus of pubis, inferior ramus of pubis, and then we have ischial
tuberosity. And we have (lesser sac foramen??? Not sure about this)
and the ischial spine. This is the inferior ramus of ischium. There is a
gap in between of pubis anteriorly, and the ischium posteriorly, and this
gap is called obturator foramen.

On the lateral surface we can see the 3 gluteal line. The anterior,
posterior and inferior gluteal line.

[p/s: the iliopectineal line and the arcuate line you can see it clearly on
u’r textbook page 175 or 311. And about the gluteal line... I also don’t
know the exact location for it. Sorry….]

How can we differentiate between the medial surface and the lateral
surface of the hip bone? Acetabulum is the side for the head of femur.
The side of articulation will be the femur. So this head of femur shows
it is the lateral surface of the hip bone.

SACRUM

Now we are going to talk about the other bone of pelvis, the sacrum,
which is triangular bone. And it has base which lies superiorly & apex
lies inferiorly. It consists of five sacral vertebrae fuse together.
Vertebral foramina together form a sacral canal.(can’t hear what the
doctor said). Do you know what is mean by vertebral foramen? What is
the foramina? What is inside of the vertebral foramen? Vertebral
foramen is the vertebral canal consists of many vertebral foramen lie
together. Vertebral foramen lie between pedicle and lamina of pelvis.
So these vertebral foramen unite together to form a sacral canal.
 The sacrum has two surfaces, anterior surfaces and posterior
sufaces. Anterior surface of sacrum has foramina and these are called
anterior sacral foramina and posterior sacral foramina. The upper
anterior part of sacrum is called promontory of sacrum. This is
posterior surface of sacrum we can see the sacral foramina. There are
four posterior sacral foramina in the posterior surface. Posterior
surface of sacrum is rough and the anterior surface of sacrum is
smooth. Also in the anterior part consists of four anterior sacral
foramina. The promontory of sacrum is the upper anterior part of the
sacrum, projecting forward. The sacrum articulate superiorly with
lumbar vertebrae to form lumbosacral joint while articulate with the
coccyx they form sacrococcygeal joint. The coccyx consists of 4
vertebrae fused together to form triangular bone which articulates
with the lower end of sacrum. The coccygeal vertebrae does not have
articular process or the spinous process consists of bodies only except
the 1st vertebra that has transverse process and cornua. What is mean
by cornua? (can’t hear clearly what the doctor said but he refer to the
diagram of coccyx). Only the first vertebra of coccyx has 2 cornua and
two transverse process.

Pelvis is divided into 2 parts: greater and lesser by pelvic brim.

Above pelvic brim is greater pelvis that is FALSE pelvis and below
pelvic brim we have TRUE pelvis form lesser brim. Pelvic brim which is
from behind forward is the promontory of sacrum posteriorly we have
the arcuate line on middle of sacrum we have ileopectineal line and we
have symphysis pubis. So all this region form the pelvic brim. So the
pelvic brim separate between true pelvis below and the false pelvis
above. The other name of true pelvis is the lesser pelvis and the false
pelvis is the greater pelvis. This is the sagittal view that show pelvic
brim. This area represent beyond this line is true pelvis, above this line
is false pelvis. This is form the pelvic outlet this axis. The other is
pelvic inlet.

p/s: The lesser pelvis (or true pelvis) is that part of the pelvic cavity
which is situated below and behind the pelvic brim.

The greater pelvis (or false pelvis) is the expanded portion of

the cavity situated above and in front of the pelvic brim

1- Pelvic inlet
2- Pelvic outlet

Between the area of pelvic inlet and outlet is the pelvic cavity. Pelvic
cavity which lie in the pelvic brim. Boundaries of false pelvis are
important. Posteriorly, we have the lumbar vertebrae. Laterally we have
iliac fossa and iliacus muscle. Iliacus muscle which lie forward the iliac
fossa.(not sure about this). Anteriorly, we have lower part of anterior
abdominal wall. True pelvis is very important in obstetric (delivery).
(can’t hear what the dr. said). The boundaries of pelvic outlet,
posteriorly we have the coccyx, anteriorly we have pubic arch and
laterally we have ischial tuberosity. (the dr. asked about the meaning
of tuberosity). Why the ischial tuberosity is rough in this area?
Because we are sitting down on ischial tuberosity.

Ligament of the pelvis.We have 4 bounded ligament:

1. Sacrotuberous lig(extend between sacrum,coccyx & ischial

tuberosity)
2. Sacrospinous lig(extend between sacrum,coccyx & ischial spinous)
Do you remember ischial spine? Spine which lie between greater ischial
foramen and lesser xxxxx (sorry cant hear his word clearly)

3. sacroiliac lig(extend between ilium & sacrum in the middle

4. Sacrococcygeal lig(extend between the sacrum above & coccyx
below)

Those are 4 important ligaments.

Obturator membrane: Fibrous sheet closes the obturator

foramen.This obturator foramen is close by obturator membrane.This
membrane enclosing leaving a small gap called obturator canal.So this is
incomplete membrane.The gap is for the nerve.
recall what is the obturator foramen?the gap lies between tuberosity
anteriorly &ischium.

Diameters of pelvic brim (pelvic inlet)

1. Anteroposterior diameter-Extends from promontory of

sacrum(this is an inlet for pelvic foramen)to theupper border of
symphysis pubis
2. Oblique diameter (12cm)-Extend from sacroiliac joint to
iliopectineal eminence
3. Transverse diameter (13cm)- Extends between furthest points
on opposite ileopectneal lines

Im talking about pelvic inlet.Now we will talk about pelvic outlet.We

have 2 type,first is anatomical outlet which line the lower border of
each bone,and second is obstetric outlet which is diamond in shape.This
table may ease you to remember

Ant.post oblique transverse

Circular Brim 11 cm 12 cm 13 cm
Circular Cavity 12 cm 12 cm 12 cm
Diamond Outlet 13 cm 12 cm 11 cm

Anterior-posterior is increasing,oblique is just the same 12 cm,and the

tranverse is decreasing.

The pelvic bone consist of the bone fascial,ligament,muscles &

peritoneum.This table shows you the wall of the pelvic.You have 4 walls:

1. Anterior wall
2. Posterior wall
3. Lateral wall
4. Inferior wall/floor
 The Pelvic wall consist of bones, fasciae, ligaments, muscles &
peritoneum. This table shows walls of pelvic cases(not sure and refer
to dr’s slides) We have 4 walls. Anterior wall, posterior wall, lateral wall
and inferior wall or floor. Anterior wall is short, form by body of pubis
and rami of pubis. Rami means branches. Rami is plural while ramus is
singular. Anterior wall also consist of symphysis pubis. While the
posterior wall is long, consist of sacrum and coccyx. Piriformis muscle
which cover this two bones and fasciae covering this muscle. Lateral
wall is formed by lower part of hip bone, obturator membrane which
cover by obturator internus muscle. Fasciae will cover the muscle. We
have 2 ligaments which is sacrotuberous ligament which run obliquely or
vertically and sacrospinous ligaments which lies transversly. All this will
form lateral wall compartment. Inferior wall form by levator ani
muscle, coccygeous muscle which lies posteriorly from the levator ani
muscle and fascia covering these 2 muscles (levator ani muscle and
coccygeous muscle).
 Anterior pelvic diaphragm has a gap. What is the meaning of the
gap??Gap is for the passage of urethra and vagina.

Levator ani muscle consist of 3 parts which are anterior fibers,

middle fibers and posterior fibers. Anterior fibers extend to sphincter
vaginae and extend to body of pubis and extend to perineal body.
Middle fibers is called puborectalis and pubococcygeus extend to body
of pubis into the anococcygeal body. Posterior fiber is called
illiococcygeus extend to pubis into coccyx and anococcygeal body.
 The action is very important. It act as a sling that support pelvic
organ. It also resists the rise in intrapelvic pressure during strain.
(Factor that can increase intrapelvic pressure : couphing, delivering,
vacation). Levator ani muscle also acts as a sphincter (anorectal
sphincter and vaginal sphincter).

Coccygeus muscle lies at posterior fiber extend to ischial spine to

lower end of sacrum an coccyx. The action is to support pelvic organs.

Vaginal Sphincter and Anorectal sphincter.

Coccygeal muscle extend between the Ischial spine and the lower end
of Sacrum and Coccyx. So Coccygeal muscle action to support pelvic
organ.
Anococcygeal body, the fibroid mass of fibroid tissue lie in the tip of
coccyx (posteriorly) and the anal canal(anteriorly) . Extend between
anal canal and tip of coccyx.

Perineal Body lies anteriorly in Anal Canal. It lies between vagina

anteriorly and anus posteriorly. It is very important in delivery which
you have to cut this Perineal Body in first delivery by disectomy.

Piriformis muscle which form posterior wall passes from sacrum,

enter through Greater Sciatic Foreman then into Greater Trochanter.
Do you know what is Greater Trochanter? It is a part of femur and
usually called as Greater Trochanter of Femur . The action of this
muscle is lateral rotation of femur.

What do we mean with Lateral Rotation, please boy? Amar! Could you
do it for me? Lateral Rotation. This is Lateral rotation.

Obturator Internus : Pelvic extend from pelvic surface of Obturator

membrane, and adjacent bone, passes through Greater Sciatic Foramen
and Greater Trochanter of Femur. It has the same action; Lateral
movement of Femur.

Pelvic Fascia formed by Connective Tissue. What do we mean by fascia?

-Line of Connective Tissue connecting muscle and bone and surrounding

organ. Above it lines abdominal wall and below with fascia of Perineum.

Pelvic Fascia is divided into Parietal Fascia and Visceral Fascia. What
do we mean with Parietal and Visceral?

Parietal : related to Wall

Viscera : related to Organ

So this fascia to the organ and this fascia toward the wall of the
pelvic. So you can see the blue color represent parietal layer of Pelvic
fascia and this one represent Visceral layer of Pelvic Fascia.

Parietal Fascia lies the wall of pelvis and overlies muscle. It’s name
refer to which part the fascia lies. For example, Obturator Internus
Fascia means fascia that cover Obturator Internus Muscle.

Pelvic fascia above the pelvic diaphragm(pelvic floor) is called Superior

Fascia layer. What are the 2 muscle covered by this fascia?

-Leverator Ani. Muscle and Piriformis muscle (?)

These 2 muscle are covered by superior layer of perietal pelvic fascia.

Continuous with internal layer is called Inferior Pelvic Fascia of

Parietal Fascia. These 2 layers are continuous to each other.

Parietal pelvic fascia cover the Sphincter Urethra and perineal

membrane forms the superior fascial layer of fascia of urogenital
diaphragm.

The visceral layer cover all the pelvic organ and some form ligament.
So, the ligament of Pelvic organ form part of Visceral Layer of Pelvic.
These ligament are Sacrocervical Lig. And Pubovesicle ligament.

Cervical mean urinary bladder.

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