113 LABORATORY 9 ‘THE SKELETAL SYSTEM The entire framework of bones and thelr cartilages, joints and ligaments make up the skeletal system. The adult human skeleton contains 206 named bones. These bones are further divided into the axial skeleton (80 bones) and the appendicular skeleton (126 bones). The axial skeleton consists of bones that form the long axis of the body ~ skull, vertebral column and thoracic cage. The appendicular skeleton consists of the bones of the upper and lower limbs, plus the bones forming the girdles that ‘connect the limbs to the axial skeleton ‘TYPES OF BONES Most bones of the body can be classified into five main types based on their shape - long, short, flat, imtegular, and sesamoid. Long bones, as the name suggests, are longer than they are wide. Most of the bones of the limios are long bones - (arm) humerus, radius, and ulna; (leg) femur, tibia, and fibula; (fingers and toes) phalanges. Long bones are slightly curved for strength, so that the stress of the body's weight is evenly distributed at several points. ‘Compact bone occurs at the surface of long bones, particularly in the diaphysis or shaft region. ‘The dilated extremities or epiphyses of the bone consist of spongy bone covered by a thin layer of compact bone. See Figure 1. Identify these features on the demonstration of a sectioned long bone. Diaotysis—} (shat) Epiphysis FIGURE 1. Longitudinal Section of a Long BoneLong Qones-longer Than They Ore wide = Shatt Dus WW Ends i. © Using your text as a reference, describe each of the other types of bones and give examples of ‘each type. Short bones_TovaNy cule Shaped (wrist bance Flatbones tna Plarkened, USvally aly cued Cotecnum, _scoplae, ribs, Most of stun) Imegular bones_have complicated Shapes that At none of the other classes (vertebrae, hip bones) Sesamoid bones _Sha: like aseasame serd- special Nope of Short bore that forers 14 a tender (patella) Chendons of hands ¢ Feet) The external surfaces of bones are rarely smooth, but instead have characteristic surface markings. Bones display projections or outgrowths that either help form joints or serve as sites of ligament and tendon attachment. Bones also have depressions which form joints and openings which allow for the passage of nerves and blood vessels. © Using your text as a reference, define the following terms: Process_any bon’ nnene Tubgrosiy Ic counded Dryection | may be ruvahened' attachment OF UL Taments Tubercle Sma it) Foun rovechen or process Trochanter_Very |cge, blunt iecegulay shaped process/ Projection Condyle_ Counded articular jectran / Nel oa jor Epicondyle_ raised Orca OF OF Above a & le. seca grout, nearly Plat articular surface (Me TEMS Crest_Nactow t'dqe of bone usually promnent Head _bory Exponsion cacrit & on a nacrouMec Foramen r oval oO \ Uva ee Meatus Comal ke pas: Sage way Fossa Mallow, basia- bite depression tn bone (Bited wy ar dined a7 mucous te mbrane )115 THE AXIAL SKELETON The axial skeleton is composed of those bones which form the long axis of the skeleton: the skull, auditory ossicles (middle ear bones — malleus, incus, stapes), hyoid bone, the vertebral column, the sternum and the ribs. 1. Examination of the Skull The skeleton of the developing embryo consists of fibrous connective tissue membranes and hyaline cartilage shaped like future bones. Gradually, ossification occurs — bone tissue starts to develop about 8 weeks after conception. This occurs in the embryonic skull by a process called intramembranous ossification. However, at birth, areas of fibrous connective tissue called fontanels, stil exist between the cranial bones. These are commonly known as the “soft spots" of a baby's skull. Functionally the fontanels provide some flexibility to the fetal skull. They allow the skull to compress as it passes through the birth ‘canal and permit rapid growth of the brain during infancy. Ossification is usually complete by two years of ‘age and the fontanels become sutures. © Identify and label the following on the infant skull, Figure 2. Frontal (anterior) fontanel Coronal suture Occipital (posterior) fontanel Sagittal suture ‘Sphenoidal (anterolateral) fontanel Mastoidal (posterolateral) fontane! Lateral View Reon¥a\ Fontore } Sagittal) Soture, Occipital Fontane) Superior View FIGURE 2. Infant Skull116 The adult skull is formed by cranial and facial bones, 22 in total. The cranial bones enclose and protect the brain and also are a site for the attachment of head and neck muscles. Sutures are immoveable joints in the adult skull and four major ones will be identified — coronal, sagittal, squamous, and lambdoid sutures. The facial bones form the face, hold the teeth and anchor the muscles of facial expression. The auditory ossicles, bones of the middie ear ~ malleus, incus and stapes can be observed in models on demonstration. © Identify and label the following on the anterior view of the adult skull, Figure 3. Frontal bone Zygomatic bones Ethmoid bone Parietal bones Maxillary bones (Maxillae) Nasal conchae ‘Temporal bones Mandible Nasal bones Sphenoid bone Lacrirnal bones Sooke poeta sprenord tempera Nose) em eal) Vor ma 2ygomae Nasa\ conchae, maxNae c mare vlory bow) mond ole FIGURE 3. Anterior View of Adult Skull © Identity and label the following on the lateral aspect of the adult skull, Figure 4. Frontal bone Mandible Ethmoid bone Parietal bone Maxillary bone (Maxilla) Lactimal bone Temporal bone Coronal suture Zygomatic bone Sphenoid bone Squamous suture Occipital bone Nasal bone Lambdold suture Mastoid process Mandibular condyle External auditory canalémeatus Styloid process17 lomlbdord suture oceptal SAGs Aempora) Frontal Spnencn etme’ S nose\ \acriera) Nigra extecaa) wf maxitior SORRY coha\ Mand blac 3 conagle, mansd process ran dibble FIGURE 4. Lateral View of Adult Skull © Whatis the only movable bone in the skull?__ Ande ¢ Whatis the practical purpose of fontanels? ON’ for caprd Oro of bear / Kull atlas for Compression Of Stoll donda bicth process © Which structure passes through the foramen magnum? _SPraa\ cord © The occipital condyles rest upon which bone? Superior ar ievlar Facers OF atlas cary © How many bones form the face? Name them, I: 2 maxilae, 2 Zygomate, Acasal, Alacrinal Ipalarne Biakteror nasal conchae | mandible |vomer Chontaljefamad hor Fey wonclag., ) mand. ble How mary bones form the 67@ orbit? Name them, “1 Bones - frontal Sphenod” Zyoqmahe maxdla palahne, lacrimal _ethmord118 © Identify and label the following on the inferior aspect of the adult skull, Figure 6, Maxillary bones (Maxillae) Palatine bone Temporal bone Occipital condyle Sphenoid bone Foramen magnum. Zygomatic arch Vorner Styloid process mat xitory bone X Zygomahe Aeenporal stylord process Oct pr¥al condyle S Faramen saqnuen oc§\ pal FIGURE 5. inferior View of Adult Skull Examination of the Hyoid Bone The hyoid bone is an isolated U-shaped bone, that lies in the anterior part of the neck just below the mandible. It functions as an attachment point for the muscles of the tongue and larynx. Itis the only bone of the body that does not directly articulate with any other bone. Identify the hyoid bone on the articulated skeleton. Examination of the Vertebral Column ‘The vertebral column constitutes the longitudinal axis of the body. It functions as a strong, flexible rod that extends from the skull to the pelvic area. It is composed of several distinct regions, each with a specific number of characteristic vertebrae. Vertebrae typically consist of a thick disc-shaped body, a vertebral foramen which contains the spinal cord, and several processes. In addition to enclosing and protecting the spinal cord, the vertebral column supports the head and serves as an attachment point for the ribs and pelvic girdle, and for the muscles of the neck and back. When viewed from the side, four curvatures give the vertebral column its $ or sinusoid shape. ‘The cervical and lumbar curves are convex119 (bulging out); the thoracic and sacral curves are concave (cupping in). These curvatures of the vertebral Column increase its strength, help maintain balance when upright, absorb shocks when moving and help protect the vertebrae from fracture. Examine each region of the vertebral column, note the number of vertebrae in each region and the characteristic features of the vertebrae that comprise each region. Cervical Vertebrae “The cervical region of the vertebral column consists of 7 vertebrae (Identified as C1 to C7). These vertebrae are the smallest and lightest in the vertebral column. Cervical vertebrae possess transverse processes that contains a transverse foramen, for the passage of the vertebral artery and vein and the associated nerves. The first two cervical vertebrae, the atlas and axis, differ in structure from the other five “typical” cervical vertebrae, The atlas (C1) is essentially a bony ring which supports the head. The superior articular facets of the atlas receive the occipital condyles of the skull. These joints allow you to nod your head to indicate “yes". The axis (C2) has a latge tooth-ike process, the dens or odontoid process, which arises from the body of the vertebra and fits up into the anterior part of the atlas. As the head is tured from side to side, the atias moves about the axis using the odontold process as a pivot point, ‘This is the joint that allows you to shake your head to indicate "no". Except for C1, C2 and C7, the spinous process is bifid, or notched at the tp. . Identify and label the following on the superior view of the atlas, Figure 6. ‘Superior articular facet Vertebral foramen ‘Transverse process Transverse foramen ior ar roulor Face} BEES Occ prea’ Condy $ OSE ON) transverse foramen rans ese Process verte bral Foraren FIGURE 6, Superior View of the Atlas . Identity and label the following on the superior view of the axis, Figure 7. Superior articular facet Vertebral foramen Transverse process Body Transverse foramen Spinous process Odontoid process (Dens) odentord process Gens) body superar achiwlar Facet vertebral Focamen transverse Poramen transverse Process Pirwis pross FIGURE 7. Superior View of the Axis120 © Identify and label the following on the superior view of @ “typical” cervical vertebra, Figure 8. Superior articular facet Vertebral foramen Body Transverse foramen Spinous process ‘Transverse process body transverie foraonen transverse proces Sogeci or articular Facet vetbeal foramen SPrnoss Process FIGURE 8. Superior View of a “Typical” Cervical Vertebra Thoracic Vertebrae The thoracic region of the vertebral column consists of 12 vertebrae (identified as T1 to T12). The distinguishing features of a “typical” thoracic vertebra are a heart-shaped body, a circular vertebral foramen, a long spinous process that points inferiorly and the presence of facets (and/or demitacets )for articulation with the ribs © Identify and label the following on the lateral view of a “typical’ thoracic vertebra, Figure 9. Body Transverse process Superior articular facet ‘Spinous process Inferior articular facet Facets for articulation with ribs Transverse Process Superior ar Nuvlar Face} Cy Ffocets forarHicvlanen wy ries bod Wa 4 [nRerror articular Facet Sprynors PTOCESS FIGURE 9. Lateral View of a “Typical” Thoracic Vertebra121 Lumbar Vertebrae ‘The lumbar region of the vertebral colurnn consists of § vertebrae (identified as L1 to LS). These are large, heavy vertebrae that are well equipped for weight-bearing. A “typical” lumbar vertebra is identified by its large size; 8 massive body, a short, “hatchet-shaped” spinous process and a triangular vertebral foramen, © Identity and label the following on the lateral view of a “typical” lumbar vertebra, Figure 10. Transverse process Spinous process Inferior articular facet. © Body body mes NS Process Sprnoos proce inkeior ark lac Face + FIGURE 10. Lateral View of a “Typical” Lumbar Vertebra Sacrum ‘The sacrum of adults consists of 5 fused sacral vertebrae. These fused vertebrae provide strong support for the pelvic girdle. The concave anterior smooth surface of the sacrum faces the pelvic cavity. The lateral surfaces of the wing-shaped alae of the sacrum articulate with the lium of each hipbone forming the sacroiliac joint Coceyx The coccyx of adults also consists of fused vertebrae. It includes 3-5 five fused coceygeal vertebrae that form the triangular ‘tailbone’. In females, the coceyx points inferiorly to allow the passage of a baby during birth while in males it points anteriorly. Identify the sacrum and cocoyx, both as individual (Cisarticulated) bones and on the articulated skeleton. 5, Examination of the Sternum The sternum is a flat bone that lies in the midline of the body and forms the anterior wall of the thoracie cage or bony thorax. The sternum consists of three fused bones: the manubrium, body and xiphold process, The clavicles (of the pectoral girdle) and the first pair of ribs articulate with the manubrium, while the following nine pairs of ribs articulate with the body of the sternum. Using the articulated skeleton, identify the fused bones that form the stemum.122 6. Examination of the Ribs Twelve pairs of ribs form the sides ofthe thoracic cage. All of the ribs attach posteriory to thoracic vertebrae. ‘The first 7 ribs have a direct anterior aitachment to the sternum. The remaining 5 ribs attach indirectly to the sternum or not at all. Identify the true, false and floating ribs on the articulated skeleton ‘and label them on the diagram of the thoracic cage. ©. Define: True Rib_Vertebrosternal (1St 7 paws) connect to sternum. divectiy by individual costal cartilage False Rib_ (TEmarmag S pars) athach iadicecty 0 Semuer OF not at ail, Ribs F-lo are vert brochoadral- costa) cachlage of Headey Ra ea CAR d pee eon hare 9a gchment to sttravm', athach only to vertebrae Posterior ly © Identify and label the following on the anterior view of the thoracic cage and rib, Figure 11 Manubrium True ribs Body of sternum ——_Sternal end of rib Xiphoid process Falseribs Floating ribs Vertebral end of rib verrheal end of nb raalend Sree FIGURE 11. Anterior View of the Thoracic Cage and Individual Ribs123 Complete the following questions about the axial skeleton. Which bone is U-shaped and located anteriorly in the upper neck? Novy od Which bones are the fist seven bones of the backbone"? Cervical verb brat Which vertebrae do the ribs articulate with? Thoratie vertt brat. Abnormal spinal curvatures may occur, Whats scoliosis? Sideways curve. of spmné | Se ‘0’ shaped’) Whatis kyphosis? Unnahsra) curving of the upper boc that creas a hunch bee “appearance. ‘What two bones contribute to the zygomatic arch?_ttmporal + Zyqomahe ‘What are the functions of the thoracic cage?_Drotechor of heark lungs, Thy om $ other sshroctvres 1A Thorocit_caviky *, Serves _as_an_gitathment ; port For muscles OF MSpirahon ) MEF oF Pecnral Gr dic Jupper hemes Pos nos 7 veicben! ‘What two bones compose the hard palate? Moxllae & palahne aryebre ‘Why are the bodies of the lumbar vertebrae so large?_We' gh beart 24 ‘THE APPENDICULAR SKELETON ‘The appendicular skeleton consists of the bones of the limbs, the pectoral (shoulder) girdle and the pelvic (hip) girdle. The pectoral and pelvic girdles serve to attach the bones of the appendages to the axial skeleton. You must be able to identify these bones on a skeleton and individually. You must know specific parts of each bone and determine if an individual bone is from the right or left side of the body. 1. Examination of the Pectoral Girdle ‘The bones of each arm articulate with the pectoral girdle, which consists of two elavicles and two scapulae, 7 Claviclo and broad and flattened on the lateral (acromial) end. ‘The medial end of the clavicle articulates ‘The clavicle (or collarbone) is an S-shaped bone; blunt and smooth on the medial (sternal) end the manubrium of the sternum and the lateral end articulates with the acromion process of the scapula. The dlavicle serves as an anterior brace which helps to prevent dislocation of the shoulder. Identify and label the following on the superior view of the right clavicle, Figure 12. Medial end Lateral end eo medial (sternal) end 49 manubruna acromial) end te Ocromion lateral ¢ ea of scapula, FIGURE 12. Superior View of the Right Clavicle124 Scapula ‘The scapula (or shoulder blade) is a large, triangular bone located on the posterior aspect of the thoracic cage. Identify the various parts of the scapula. © Identify and tabe! the following on the right scapula, Figure 13. Superior border ‘Acromion process Spine Medial border Coracoid process Inferior angle Lateral border Gienoid cavity (Fossa) Superior bo ber Coracord process OLFOMION PrOKAS Nero d cau Ie spine medial border lakra) border inferior angle FIGURE 13. Posterior View of the Right Scapula Examination of the Upper Limb ‘The skeleton of the upper limbs consists of the bones of the arms, forearms, wrists and hands, ‘The arm (or brachium) contains a single bone, the humerus. The ulna and radius make up the forearm (or antebrachium). The wrist (or carpus) consists of elght carpal bones and the hand contains five metacarpal bones and fourteen phalanges. Humorus The humerus is the largest and longest bone of the upper limb, extending from the shoulder to the elbow. The proximal end of the humerus, the rounded head, articulates with the glenold cavity of the ‘scapula and the distal end articulates with the radius and ulna.125 © Identify and label the following structures on the right humerus, Figure 14 ‘Anatomical neck Greater tubercle Lesser tubercle Head Trochiea Capitulum Medial epicondyle _—Lateral epicondyle ——_Deltoid tuberosity Olecranon fossa : read Og ple) Rhee great tubercle anatemica\ neck Caprtolun, Peas) redial Cecranon FOSso eprconye teal TroGhye a. epicondyle anterorview Cla) Posterior view FIGURE 14. Anterior and Posterior Views of the Right Humerus Uina and Radius. The forearm consists of the ulna and the radius. In anatomical position, the ulna is on the medial ‘side and the radius is on the lateral side. The proximal end of the ulna articulates with the humerus, Dis- tally, the ulna does not articulate directly with the carpal bones, but with a disc of fibrocartilage. ‘The proximal end of the radius, the head, is a rounded platelike structure with a thick margin. The head of the radius articulates with the humerus and ulna. Distally, the radius is expanded to articulate with the carpal bones of the wrists. © Identify and label the following on the right ulna and radius, Figure 16. Uina: Olecranon process Radius: Head of radius Trochlear (semilunar) notch Styloid process of radius Shaft of ulna Razial tuberosity126 Oletrano? process trochiear ootch Srytord process, radws Radius UIna FIGURE 15. Anterior View of the Right Radius and Ulna a4 Carpal Bonés, the Metacarpal Bones and the Phalangés The wrist contains eight small carpal bones, arranged in two rows of four bones each. It is not necessary to know the names of the individual carpal bones. The five metacarpal bones form the framework ofthe body of the hand. The metacarpal bones are identified by Roman Numerals | to V, beginning with the lateral metacarpal bone. These bones are relatively long and cylindrical and their distal ends form the knuckles. The metacarpal bones articulate proximally with the carpals of the wrist and distally with the phalanges of the fingers, The metacarpal bone Which forms the thumb has a wide range of movement. This is due to the saddie type of joint between this metacarpal and its associated carpal. It is called an opposable thumb because of the ability to oppose the thumb to the fingers. This gives the human hand its dexterity and manipulative ability. The phalanges are the finger bones. An individual finger bone is called a phalanx. Each finger is composed of three phalanges: the proximal phalanx, the middle phalanx and the distal phalanx. The thumb has only two phalanges, the proximal and distal phalanx. There are fourtesn phalanges in each hand.127 © Identify and label the following on the hand, Figure 16. Carpal bones Metacarpal bones Phalanges Proximal phalanx Middle phalanx Distal phalanx carpals 6 g) metacerpals (s) Prolanges ay) ‘Singpldr’. phalanx phalanx middle pralank distal, pralaax FIGURE 16. Posterior View of the Left Hand 3. Examination of the Pelvic Girdle The pelvic girdle is a strong bony ring attached to the sacrum of the vertebral column, The ring is composed of two hip bones or coxae (os coxae oF coxal bones) which unite anteriorly at the puble symphysis. Originally, each coxa consists of three separate bones: the ium, the Ischium and the ‘As development progresses, these bones fuse to form one solid bone. Their names, however, are for purposes of identification. “The coxae, the sacrum and the coccyx form the bony pelvis, Table 1 lists some of the anatomical differences that should be noticed in the examination of the pelvis of a male and a female. The fetus must pass through the narrow inferior opening of the pelvic cavity in females during birth. Identify the sex of ‘each pelvis on the skeletons and disarticulated pelvises. © Define: True Pevis CAcloses pele cavrty = loony edge is _pelvre bein enclosing pelute toler128 False Pelvis_ Consists of expanded portions of jive above luce berm - bounded by iia laterally & lumbar vertthrae Postrion ly TABLE 1. Comparison of Male and Female Pelvises Characteristic Male Female General Structure Deep and narrow Shallow and wide Bone Thickness Heavy and thick Light and thin. Pubic Angle (Arch) Acute (sharp) Broad (round) Pelvie Brim Heart-shaped Oval (large) Acetabula Large and close together Small and far apart . Identify and tabel the following on the right os coxa, Figure 17. Niu Greater sciatic notch Pubis Iliac crest Acetabulum Obturator foramen Ischium \schial spine Ischial tuberosity. ae Orest ium yreakee tion acefabslurs nore Femur ischia) spine ischicn pubis ischial obtratoe Wherost ramen FIGURE 17. Lateral View of the Right Os Coxa129 ‘© Identify the sex and label the following on the pelvises, Figure 18. Sacrum Coccyx Pubic symphysis, Pubis Acetabulum Ischium, Hur ‘Obturator foramen acetobulum obturatyr Porane® soc_fimale FIGURE 18, Anterior View of Pelvises 4, Examination of the Lower Limb. ‘The skeleton of the lower limbs consists of the bones of the thighs, kneecaps, legs, ankles and feet. The thigh contains a single bone, the femur. The kneecap is formed by the patella, The tibia and fibula make up the leg. The ankle (or tarsus) consists of seven tarsal bones and the foot contains five metatarsal bones and fourteen phalanges. Femur The femur is the longest and heaviest bone in the body, extending from the hip to the knee joint. ‘The proximal end of the femur, the head, articulates with the acetabulum of the pelvis. The distal end, formed by the lateral and medial condyles, articulates with the tibia of the leg.Patella 130 ‘The patella is a triangular sesamoid bone, located anterior to the knee joint, It is embedded in the tendon of the quadriceps femoris muscle (the principal anterior thigh muscle) where it crosses the knee joint to insert on the tibia, Identify the patella on the articulated skeleton. Tibia and Fibula The tibia (or shin bone) is the medial and larger bone of the leg. It serves to transmit the weight of the body from the femur onto the foot. The fibula, on the other hand, is a long, slender bone on the lateral side of the leg. Itis not a weight bearing bone and does not enter into the formation of the knee joint. © Identity and abel the following on the left femur, Figure 19, Head Shaft Lateral condyle Neck Patellar surface Intercondylarfossa_ Medial condyle Greater trochanter rector trochanter Peas (to ocebabslve) neck Smoke patellar surfacr latera) condyle lake con dyloe Rasa medrol condyle Anterior view Posterior view FIGURE 19. Anterior and Posterior View of the Left Femur131 © Identify the following on the left tibia and fibula, Figure 20. Tibia: Proximal end Fibula: Head Tibial tuberosity Distal end Medial malleolus proximal end head Hidbia\ bbecas hy Toi 4 Pare Erato, Ciarecal) medial maleaug Rsra\ end Tibia Fibula FIGURE 20. Anterior View of the Left Tibia and Fibula 4) is) ad ‘Tarsal Borles, the Metatarsal Bones and the Phalanges: ‘The structure of the foot is basically similar to that of the hand. The ankle is composed of seven tarsal bones. The talus is the tarsal bone which articulates with the tibia and the fibula. The calcaneus is the large, strong heel bone. Five metatarsal bones extend from the tarsal bones to the “ball” of the foot, to form the plantar surface (the sole). These bones articulate with the phalanges or toes bones. All toes, with the exception of the "big" toe, are composed of three phalanges. The latler is comparable to the thumb as it is composed of only two phalanges.132 e Identify the following and label them on the left foot, Figure 21. Tarsal bones Metatarsal bones: Phalanges Calcaneus Talus Navicular Proximal phalanx Middle phalanx Distal phalanx Calcangous. Chee!) Xolus Govroe | ovsas (1) Novicvloy, | I middle Pralann, val Pratank FIGURE 21. Superior View of the Left Foot merocrorsais (S) Pralanges as) © Which bone articulates with the acetabulum and the tibia? __ Penne © Which bone is the one you "sit down on"?__1SChiLen © Towhich bone of the axial skeleton does the pectoral girdle attach? _MA&nubrium Of Steefum, © What bones compose the palm of the hand?_Metacarpals © Name the three bones that compose the os coxae._i tive, ischium, pubis133 Label the bones indicated on the human skeleton, Figures 22 and 23. ont! Zygomahe posal d worlla mondible % cecvicle vert brat clavicle monubety loody of aA tre rib dein Xiphord PrOUess Floahai costal carhlage ab 7 Jumbar verk brat rads, Hoe He Sacrum ony x carpals Ba metawrpals 4 ae proxi mal phalanx Xsral Pholanx Femur Portela, Abia Rola tarsols xi Amen) metatarsals Phalanx dictal pinalanx FIGURE 22. Anterior View of Human Skeletonvetal é Parietal Sagvtad Suv occipital fambdod Suture olovicle Scapala Vu mernt, Thoracic Verit brae, wlna f a | ‘ s» Th rods Soerory VSN On metacerpals, pa \ Prowogialanx Remae ™ poker lakera\ cond, : inteccondylor sso. Abia Rovio Calcaneus FIGURE 23. Posterior View of Human Skeleton