_______ _______ _______ ________.
____
___.,.____._ C h op t -e
I 2
Bones
,:- 'Jo ,,.~/rad n/ rl>NJm , mo,,,. i11,lcnd of} mc,/i/a lc; mo.I~i11, lcrut of mi,/,, . ❖
-Swami Vivekananda
INTRODUCTION
Various bones of the lower limb have been enumerated
in the previous chapter. The bones are described one
by one below. The description of each bone is given in
two parts. The first part introduces the main features
and the second part describes the muscular and
ligamentous attachments.
Competency achievement: The student should be able to:
AN 14.1 Identify the given bone, its side, important features and
keep it in anatomical position.1
AN 14.2 Identify and describe joints formed by the given bone.2
HIP BONE
Hip/innominate bone is a large irregular bone. It is
made up of three parts. These are the ilium (Latin loin)
superiorly, the pubis (Latin genital area) anteroinferiorly,
and the ischium (Greek hip joint) posteroinferiorly. The
three parts are joined to each other at a cup-shaped
hollow, called the acetabulum (Latin vinegar cup). The
pubis and ischium are separated by a large oval opening
called the obturator Joramen.
The acetabulum articulates with the head of the
femur to form the hip joint. The pubic parts of the two
hip bones meet anteriorly to form the pubic symphysis.
The two hip bones form the pelvic or hip girdle. The
bony pelvis is formed by the two hip bones along with
the sacrum and coccyx.
Side Determination
1 The acetabulum i!; directed laterally.
2 The flat, expanded ilium forms the upper part of the
bone, that lies above the acetabulurn.
3 The obturator foramen lies below the acetabulum. lt
is bounded anteriorly by the thin pubis, and
posteriorly by the thick and strong ischium.
7
Anatomical Position
1 The pubic tubercle and anterior superior iliac spine
lie in the same coronal plane.
2 The pelvic surface of the body of the pubis is directed
backwards and upwards.
3 The symphyseal surface of the body of the pubis lies
in the median plane.
ILIUM
The ilium or flank forms the upper expanded plate-like
part of the hip bone. Its lower part forms the upper
two-fifths of the acetabulum. The ilium has the
following.
1 An upper end, is called the iliac crest.
2 A lower end, is smaller, and is fused with the pubis
and the ischium at the acetabulum. The ilium forms
the upper two-fifths of the acetabulum.
3 Three borders-anterior, posterior and medial.
4 Three surfaces-gluteal surface, iliac surface or iliac
fossa, and a sacropelvic surface.
Iliac Crest
The iliac crest (Fig. 2.1) is a broad convex ridge forming
the upper end of the ilium. It can be felt in the living
at the lower limit of the flank.
Curvatures: Vertically, it is convex upwards, antero-
posteriorly; it is concave inwards in front and concave
outwards behind (Fig. 2.1).
The highest point of the iliac crest is situated a little behind
the midpoint of the crest. It lies at the level of the interval
between the spines of vertebrae L3 and L4.
Ends: The anterior end of the iliac crest is called the
anterior superior iliac spine (ASIS). This is a prominent
landmark that is easily felt in the living. The posterior
~ - ~LO~\~VE~
R~U~M~
B- - - - - - - - - - - - - - - -- - - - - - ~

. d begins a little above and behind

end of ~ e crest is called the ro~terivr ~11pcrior iliac spine. the mos t il1-d~f 11f1e .' spine runs backwa rds 'nd
lh:- pos1hon on the surface of the bod\' is marked by a • . n enor ' "
the an ter10 1 1 d near the apex of the greater sciaij
dimpl_c 5_cm lateral of the second ; acrnl spine (S2) downw ards to en
(ffi' Fig. ~- t ). c
notch.
:~fo'J1!'.Dl~"i~·11I di. i..,io11s: ~forphologically, the iliac crest
1

LS dn 1ded mto a long ,'t'ntml segment and a short dorsal mac Fossa .
~ t l lf 11 t. . . I1 lar e concave area on the :11-°er surface
lhac fossa is t ~ g d . front of its medial border It
Tum situate m . .
The Yentral segmen t forms more than the anterior of tl1e i 1 ' all of the false pelvis (Fig. 2.2). ·
two-thi rds of the crest. It has an outer lip, an inner lip, forms the latera1w
and an intem1e diate area. The tubercle of the iliac crest
is an eleYation that lies on the outer lip about 5 cm sacropelvic Surface .
behind the anterio r superio r iliac spine (Fig. 2.1). · 1 . rface is the uneven area on the inner
Sacrope v1c su . d· d ' 1b
The dorsal segmen t forms less than the posterior one- surface of th e i•1·m m ' situated behm its·1·me iab order·
third of the crest. It has a lateral and a medial slope .
I t lS bd' 'ded m·to three parts-t he 1 tac tu erosity
SU ivi · f ·· '
separat ed by a ridge. the auricular surface and the pelvic sur ace. The z!iac
tuberosihJ is the upper, large, roughe ~~d area/ lymg
Anterio r Border just below the dorsal segmen t of the 1hac crest. It is
· d · the middle and depress ed both above and
Anterio r border starts at the anterior superior iliac spine raise m · l
below (Fig. 2.2). The auricula r sur1,f.a~~ 1s
·
arhcu ~r but
and runs dmvnw ards to the acetabulum. The upper part pitted. It lies anteroin ferior to the ihac tub~~os1_ty_. It
of the border present s a notch, while its lower part articulates with the sacrum to form the sacroiliac JOmt.
shows an elevate d area called the anterior inferior iliac
The pelvic surface is smooth and lies anteroinferior to
spine. The lower half of this spine is large, triangular the auricula r surface . It forms a part of the lateral wall
and rough. of the true pelvis. Along the upper border of the
o-reater sciatic notch, this surface is marked by the
Posterior Border preauricular sulcus. This sulcus is deeper in females '
Posteri or border extends from the posterior superior than in males.
iliac spine to the upper end of the posterior border_ of
the ischium . A few centimetres below the posterior Attachments
superio r iliac spine, it pres~1_1ts ai:other_ prominence is
1 The anterior superior iliac spine gives attachment to
called the posterior inferior iliac spine. Still lower down
the lateral end of the inguina l ligament. It also gives
the posteri or border is marked by a large deep notch
origin to the sartoriu s muscle ; the origin extends
called the greater sciatic notch (Fig. 2.1).
onto the upper half of the notch below the spine
(Figs 2.3 and 2.5).
Medial Border
2 The outer lip of the iliac crest provides:
Medial border extend s on the inner or pelv~c_surfa~e
of the ilium from the iliac crest to the 1hopub ic a. Attachment to the fascia lata in its whole extent.
eminen ce. It separa tes the iliac fossa from the b. Origin to the tensor fasciae latae in front of the
.D
sacrope lvic surface . Its lower rounde d part for~s
E
::; the iliac parts of the arcuate line or inlet of pelvis
tubercle.
c. Insertio n to the externa l oblique muscle in its
(Fig. 2.2). anterior two-thirds.

Gluteal Surface d. Origin to latissim us dorsi just behind higheSt

Gluteal surface is the outer surface of the i~ium, w~~ch point of the crest. Tuberc le of crest gives
is convex in front and concav e behind , like the iliac attachm ent to the iliotibial tract (see Fig. 3.8).
crest. It is divided into four areas
. (F'
?Y
three gluteal 3 The_ intermediate area of the iliac crest gives ori~ to
Imes 1g. • ·2 1) The posterior gluteal /me, the shortes t, the mternal oblique muscle in its anterior two-fuirdS-
. 5 . front of the · ·1·
begms cm m posteri or superio r I iac 4 The inner lip of the iliac crest provides:
. and runs downw ards to end at uppery ar t of
spme, . f otch The anterior gluteal /me, the a. Origin to the transve rsus abdorninis in its anterior
greater scia i_c n b . t 4 cm behind the anterio r two-thirds (Figs 2.4 and 2.5).
longe~ t, ~e?ms ainoeu runs backw ards and then
b. Attachment to the fascia transversalis and to the
superi or iltac sp at ihe middle of the upper bor?er fascia iliaca in its anterio r two-thi rds, deep to the
downw ards to e~d . tch The inferior gluteal lme1
of the greater sciatic no . attachment of the transve rsus abdominis.
- - - - - - - - - - -- -
- - -- -- - - -- ---- ~B
O~ N~ E:i __S_ _ Jpll
c. Orig in to U,e q d .
one-U,ird (Fig~1;_4rtus lumborum in its post PUBIS
erio r
d. Atta chm ent to the tl Pubis forms the anteroinferior part of the
the atta clun ent of t1 "loracolumbar fascia hip bon e and
arou the ante rior one-fifth of the acet abu lum
Tl ,e quad ratu s lum boru m nd , form s the
5 ,e atta clun ents on the d anterior bou ndar y of the obtu rato r foramen
I . It has:
are as follows. orsa segment of tl1e iliac.crest a. A body anteriorly.
a. The late ral slop e ives . . b. A superior rarnus superolaterally.
maxi.mus (Fig.
25 / ong m to the glut eus c. An inferior rarnus inferolaterally (Figs 2.1
and 2.2).
b. T11e med
. ial slop e giv • m
. to the erect
es ong or spinae Body
c. T\1e mte ross eous and dors al sacr
oiliac ligament~ Body of pubis is flattened from before back
are
tt atta
hrnched to the med ial mar gin . d war ds, and
a ac ent of the erector spinae (Fig. eep 2.4).
to the has:
6 T~e ~pp er half of the anterior inferior iliac 1 A superior bord er called the pubic crest.
spine gives 2 A pubic tubercle at the lateral end of
ong m to the stra ight hea d of the rectus femo the pub ic crest.
ris. The 3 Three surfaces, viz. anterior, posterior and
rou? ~ low er pa~t of this spin e gives attac medial.
the iliofemoral liga men t (Fig . 2. ). hme nt to
14 The pubic tubercle is the lateral end of the pub
ic crest,
7 The posterior border of the ilium provides forming an imp orta nt land mar k (Fig. 2.1).
:
a. 1?-ttachrnent to upp er fibres of the sacr The_anterior surface is directed dow nwa rds, forw
otuberous ards
liga men t abov e the grea ter sciatic notch. and slightly laterally. It is roug h superom
edially and
b. Or i~ to few fibres of the piriformis from smo oth elsewhere.
upp er
mar gm of the grea ter sciatic notc h (Fig. 2.3). The posterior or pelvic surface is smooth. It is
directed
8 The atta chm ents on the gluteal surface are upw ards and backwards. It forms the ante
as follows. rior wall of
a. ~e _area beh ind t~e post erio r gluteal the true pelv is, and is related to the urin ary
line gives blad der.
ong m to upp er fibres of the glut eus max The medial or syrnphyseal surface articulates
imu s with the
(Fig. 2.3). opposite pub is to form the pubic symphys
is.
b. The glut eus med ius arises from the area
betw een Superior Ramus .
the ante rior and post erio r gluteal lines (Fig.
2.3). Superior ram us extends from the bod y of
c. The glut eus rninimus arises from the area the pubis to
betw een the acetabulum, above the obturator fora
the ante rior and inferior gluteal lines (Fig men. It has
. 2.3). three bord ers and three surfaces.
d. Below the infe rior glut eal line, the refle
cted head 1?e s~perior bord er is called the pectineal line
pubi~ . It 1s a sharp crest extending from just behi pecten
of the rect us femoris arises from the groove or
above
the acet abu lum (Fig. 2.3). . nd the
pu~1c tuberc~e to the post erio r part of the
e. The caps ular liga men t of the hip joint iliopubic
is attached eminence. With the pubic crest it forms the
alon g the mar gin of acet abul um. pubic part
of the arcuate line (Fig . 2.1).
9 The iliac fossa give s orig in to the iliac The anterior bord er is called the obturator
us from its crest. The
upp er two -thi rds (Fig. 2.4). The low er groo bord er is a roun ded ridge, extending from
ved part the pubic
of the fossa is cov ered by the iliac burs a. tubercle to the acetabular notch.
10 The iliac tuberosity prov ides atta chm .C
ent to: The inferior border is shar p and form s the
a. The inte ross eous sacroiliac liga men t in mar gin of the obturator foramen.
upp er E
its grea ter ::i
part (Fig . 2.4). The pectineal surface is a triangular area betw
een the Q>
b. The dors al sacroiliac liga men t posterio anterior and superior bord ers, extending from
rly. tubercle to the iliopubic eminence.
the pubic ~
c. The iliol umb ar liga men t supe riorl y.
The pelvic surfa ce lies betw een the supe
.9
11 The con vex mar gin of the auricular rior and
surface give s inferior bord ers. It is smo oth and is cont
atta chm ent to ven tral sacroiliac ligamen inuous with
t. the pelvic surface of the bod y of the pub is
12 The atta chm ents on the pelv ic surface (Fig . 2.2).
are as follows. The obturator surface lies betw een the ante
a. The prea uric ular sulc us prov ides atta rior and
chm ent to inferior bord ers. It pres ents the obturator
the low er fibres of the ven tral sacroiliac liga groove.
ment.
b. The par t of the pelv ic surf ace late Inferior Ramus
ral to the
prea uric ular sulc us gives orig in to a few Inferior ram us exte nds from the bod y of
fibres of the pub is to
the pirif orm is. the ram us of the isch ium, med ial to the
obtu rato r
c. The rest of the pelv ic surf ace gives orig foramen . lt unites with the ram us of the isch
in to the ium to form
upp er half of the obtu rato r inte rnus (Fig the conj oine d isch iopu bic ram i. For conv
. 2.4). enie nce of
 ~ ~ ~ - -- - - --------------
lOWERLIMB

I f- tG "'

----"-- - - - - - Iliac crest

~ r - - - - - Tubercle

I Ilium - - - -- - - -~,£.--
,,.,~ - - - - - - - - - \ - , r - - -- Anterior gluteal line

Anterior superior iliac spine

Posterior gluteal line - - - -+-1--~
Anterior border
Postenor supenor iliac spine - - - -
_.,..,c_-- - - --+--- -- Inferior gluteal line
Posterior border - - - ------\ Anterior inferior iliac spine

Postenor inferior iliac spine - - - - - - --::.,, Acetabulum

Pectineal surface and pectineal ,-1
Greater sciatic notch _ _ _ __ __./ of superior ramus ne
Anterior border of superior ramus
lschial spine _ _ _ _ _ _ _ _ __,.
Pubic tubercle and pubic crest
Dorsal surface of ischium - - - - - - - - - - - 1 - -
Pubis-anterior surface

lschial tuberosity - -- - - -- - ---- Medial surface

Inferior border of superior ramus
Femoral surface of ischium - -- - ----------'µ~__,
Inferior ramus
lschiopubic ramus

Fig. 2.1: Outer surface of right hip bone

Medial border
Iliac fossa - ------,h i -- -- -

Iliac tuberosity

...,;_*'---+-- - - - Auricular surface

Preauricular sulcus
lliopubic eminence - - - - - - - - i - - - - ' -

' - - - - - - - - - Greater sciatic notch

Obturator fora men - - - -

lschial spine
Pelvic surface of superior ramus - - - ----,,L--

Lesser sciatic notch

Symphyseal surface of pubis - -- -~ ::..J....

Posterior border and pelvic

surface of ischium
Obturator membrane - - - - - - - - _ _ /

Fig. 2 .2: Inner surface of right hip bone

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _..:::.,__;_-- 11
BONES --

Iliac crest - - - - - - ~
Lowest fibres of latissimus dorsi - - - - - - - - - - - Internal oblique
Gluteus medius - - - - _ ~ - - - - External oblique

Gluteus minimus -------

Gluteus maximus
Tensor fasciae latae
Posterior gluteal line
Anterior gluteal line

Sartorius
Some fibres of piriformis
- -- -1~-- - Inferior gluteal line
Greater sciatic notch - - - -
~ - - - - Rectus femoris-straight head
Acetabular notch - - - - --r----_ - - -'-,J!__ _ _ _ _ Rectus femoris-reflected head
Superior gemellus
--+---+------ Acetabulum
lschial spine - --""""-
Pectineus
Lesser sciatic notch - - - - Pubic tubercle
Inferior gemellus Rectus abdominis
,...,____ Pyramidalis
Semimembranosus
' - - - - Adductor longus
Semitendinosus and long head of
biceps femoris ._________ Gracilis

lschial tuberosity Adductor brevis

Obturator externus
Quadratus femoris _ _ ___,
'-- - - -- -- - - -- Adductor magnus

Fig. 2.3: Attachments on the outer surface of the right hip bone

Quadratus lumborum
Transversus abdominis
Iliac crest lliolumbar ligament
Dorsal sacroiliac ligament
lliacus Erector spinae
lnterosseous sacroiliac ligament

Anterior superior iliac spine

Auricular surface
Anterior inferior iliac spine
Ventral sacroiliac ligament
Straight head of rectus femoris .c
Greater sciatic notch E
Psoas minor ::::i
Coccygeus
...
Q)
lschial spine ~
Body of pubis
Levator ani (posterior fibres) .9
Pubic tubercle Obturator internus

Levator ani (anterior fibres) Endopelvic fascia

Obturator internus

Dorsal nerve of penis/clitoris and

internal pudenda! vessels Deep transversus perinei

Grus penis/clitoris
Perinea! membrane
lschiocavernosus - - - - - - - -- - ~ ' - - - - - - - - -- - Superficial transversus perinei

Fig. 2.4: Attachments on the inner surface of the right hip bone
- 12 :· - -L- . ::.:.:.:.::..
OWER LIMB _ __ __ _ _ __ _ __ _ _ __

5 The riec/'lueol 11 11 ,, 11 ,.·ovld,m nttndwwnt lo:

o, The conjoin t lcndon nt the mcdhi l 1.: nd.
Gluteus
maximus - Erector b. The lnclmor ligo rn cnl at ~he mcJl_~I '' 1tt 111 fron\
of lhc nttochrncnt nf the t;nnjolnt tendon.
1

splnoo
c. The pcctlncn l llgonicnl ~,f Co_ oper_nhmg th,3wh,)J,1
length of the line lotc:r_
,~l t~ tl~c otlo<:; hm4;nt of lh,:
Latissimus lncmrnr lig()mcnt (01:e P,g. l6. lG),
dorsi d. The pcctl ncw, ,nui, ; dc whlch i:irisc~ifrom lhc whol11
length of the line (Pig. 2,3),
lntornal c. 'The foscio coveri ng the pcctln1;w;.
oblique
f. The psons minor, which ifl lnf-lcrted lwru wlwn
present. , .
External
oblique Transversus 6 The Lipper pnrt of the pl!cl'inenl t,jf/rfr:";1; givcMorigin Iv
abdomlnls the pcctincus (Pig. 2.3).
7 The pelvic s111jnce is crnsscd by row1d llgame'.1t of th 1:
Tubercle uterLJS in fcmn lcH rind by tht! ductw, dcfon:ritt 111 mak•>
of iliac
crest (see Chaptcrti 3'1 .:ind 32).
Posterior 8 The obt11 mtorgroove (Pi~. 2,2) L1·a11srn lls tht: obltrrator
Tensor vessels and nerve.
fasciae Lateral+ Medial
tatae 9 Sec oltnchmcnh, on cnnjoin<1d it-;chiopubk r.1rn i with
Sartorius Anterior ischiurn.
Fig. 2.5: Attachments on the right iliac crest (as seen from above)
ISCHIUM
description, the conjoined rami will be considered The ischiurn form s tht! prnllcroinfcrior· part of the hip
together at the end (refer to BDC App). bone, .ind the odjoining two-fiftl1H of th l.! ncetabulum.
It forms th e posted.o r boundary of th e obturntor
Attachments and Relations fornmen. The ischium hai, n body ,rnd a ramw, (Pigs 2.1
1 The pubic tubercle provides attachment to the medial to 2.4).
end of the inguinal ligament (see Fig. 3.2) and to
ascending loops of the cremaster muscle (see Fig.16.17). Body
In males, the tubercle is crossed by the spermatic cord This is n thick oncl m<1ssivc mnsn of bone that lies below
(see Fig. 16.13). ond behind the c1cetnbulum. It ha1,:
2 The medial part of the pubic crest is crossed by the Two ends-upper nnd lower;
medial head of the rectus abdominis. The lateral part :rh rce bordcrs- <1nterior, posteri or nnd Jntern l;
of the crest gives origin to the lateral head of the [hrec surfoces- fcmorn l, dornc1 l and pelvic.
rectus abdominis, and to the pyramidalis (Fig. 2.3).
Ends
3 The anterior surface of the body of the pubis
provides: . . . 1 The upper end form s the postcroin fc ri or two-fifthsof
a. Attachment to the anterior pubic ligament medrnlly. th?. acetabulum. _The ischium 1 ilium and pubis fuse
b. Origin to the adductor longus in the angle between with ench other in the acetabu lu m.
the crest and the symphysis (Pig. 2.3). . 2 The lower,end_fo ~ms ~he ischia/ tuberosity. It gives off
c. Origin to the gracilis ,. fro1:1 the margin of th? rnmu1;; of the 1sch1um which fo rms an acute angle
symphysis, and from the m~enor ramus. . . with the bod y.
d . Origin to the adductor brev1s lateral to the origin
Bordars
of the gracilis (Fig. 2.3). .
e. Origin to the obturator exlcrnus neor the margin 1 The an/'erior bord('r · £•,rm
, :;. th. e postcrwr • margin · of the
of the obturator foramen (Fig. 2.3). obturntor fornm en.
,- 4 The posterior surface of the bo~y of th~ pubi~provid es:_ 2 The posterior
. borcJ,,r · ·, t'
~ us con 1nuoL1 s :1bovc wit
· h the
a. Origin to the /evator ant from Lts middle part posteri.or border of the iii um. 8,1· ' ,-t , ds at the
c: lipper e11 d 0 f h . . . cow, J en
0 (Fig. 2.4). . . 4) ·h· . , t e ischinl tuberollity. It also forms part
f
tsQ) b.c. Origin to the obtura tor mtcrnus la~crn lly (Fig.~- · ,
Attachment to the puboprostat1c/pubov c:;1ca l
o l. c low<.! r border f ti
the notch the po ·t,?. · · f3 I w
1c grea~cr sciatic notch. _ c?
, II • . . · . :; ~ri ur margin shows a proJedHJ11
Cl)
ligaments medial to the attachment of the lcvatur t' ~cl thhe isdua/ sptne. 13<.! luw the spine the posterior
Jor er 8 ows n conc.:ivity, called the lessa sciatic notclr.
ani.
 BONES -
- -- - - -- - - - - - - -- - - -- - - - - - - 13

3 TI,c /11/crn/ /,order forms the lateral margin of the Attachments and Relations
ischial hibcrosity, except at the upper end where it 1 The isc/1ial spine provides:
is rounded. a. Attachment to the sacrospinous ligament along
its margins (Fig. 2.6). .
Surfaces b. Origin for the posterior fibres of the levator aru
1 The femoral s111face lies between the anterior and from its pelvic surface (Fig. 2.4). Its dorsal surface
lateral borders (Fig. 2.1). is crossed by pudenda! nerve, the internal
2 TI1e dorsal s11,face is continuous above with the gluteal pudenda! vessels and by the nerve to the obturator
surface of the ilium. From above downwards, it intemus (see Fig. 5.14).
presents a convex surface adjoining the acetabulum, 2 The lesser sciatic notch is occupied by the tendon of
a wide shallow groove, and the upper part of the the obturator intemus. There is a bursa deep to the
ischial tuberosity. tendon. The notch is lined by hyaline cartilage. The
The ischial tuberosity is divided by a transverse upper and lower margins of the notch give origin to
ridge into an upper and a lower area. The upper area the superior and inferior gemelli respectively (Fig. 2.3).
is subdivided by an oblique ridge into a superolateral Gemellus is derived from gemini, which means
area and an inferomedial area. The lower area is 'twin'. Gemini is a sun sign.
subdivided by a longitudinal ridge into outer and 3 The femoral surface of the ischium gives origin to:
inner area (Fig. 2.6).
a. The obturator extemus along the margin of the
3 The pelvic surface is smooth and forms part of the
obturator foramen.
lateral wall of the true pelvis.
b. The quadratus femoris along the lateral border of
Conjoined lschiopubic Rami the upper part of the ischial tuberosity (Fig. 2.3).
The inferior ramus of the pubis unites with the ramus 4 The dorsal surface of the ischium has the following
of the ischium on the medial side of the obturator relationships. The upper convex area is related to the
foramen. The site of union may be marked by a piriformis, the sciatic nerve, and the nerve to the
localized thickening. The conjoined rami have: quadratus femoris (see Fig. 5.15).
5 The attachments on the ischial tuberosity are as
Borders: Upper and lower follows:
1 The upper border forms part of the margin of the • The superolateral area gives origin to the
obturator foramen. semimembranosus (Fig. 2.6)
2 The lower border forms the pubic arch along with the • The inferomedial area to the sernitendinosus and
corresponding border of the bone of the opposite side. the long head of the biceps femoris
• The outer lower area to the adductor magnus
Surfaces: Inner and outer (Fig. 2.6)
1 The inner surface is convex and smooth. It is divided • The inner lower area is covered with fibrofatty
into three areas, upper, middle and lower, by two ridges. tissue and a bursa which supports body weight
2 The outer surface is rough for the attachment of in the sitting position. While standing, this area is
muscles. covered by gluteus maximus muscle.
• The sharp medial margin of the tuberosity gives .0
attachment to the sacrotuberous ligament (Fig. 2.6). ~
lschial spine with
sacrospinous ligament
• The lateral border of the ischial tuberosity provides ...
Acetabular margin attachment to the ischiofemoral ligament, just ~
Lesser sciatic notch Semlmembranosus below the acetabulum. .9
Semltendinosus and long Oblique ridge 6 The greater part of the pelvic surface of the ischium
head of biceps femoris
gives origin to the obturator internus. The lower end
Sacrotuberous ligament Transverse ridge of this surface forms part of the lateral wall of the
Inner lower aroa ___,,/,, Longitudinal ridge ischioanal fossa (Fig. 2.4).
wilh a bursa
7 The attachments on the conjoined ischiopubic rami are
Adductor magnus
(lschlal head) Medial +
Superior

Inferior
Lateral
as follows:
a. The upper border gives attachment to the obturator
membrane.
b. The lower border provides attachment to the fascia
Fig. 2.6: Posterior view of the right ischlal tuberoslty and Its lata, and to the membranous layer of superficial
attachments fascia or Colles' fascia of the perineum.
,l_. l__
1_4
~l~O~
W~ER~ll~M~B_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
__ _ _ ________

c. The muscles taking origin from the outer surface 1 ed articula r surface or ltinnte
are: 5 A hors~shoe-s ~~he
anterior, superior, and posterior
surface is ~een ~~tabulmn. It is lined with hynline
i. The obtu ra tor externu s, near the obturat or
margin of both rami (Fig. 2.3). parts of the ac·t· !ates with the head of the femur
t' l ge ·rnd
car 1 a , ' . ar. .icu
t The fibrocarh·1 agmous
' .
ii. The adducto r brevis, chiefly from the pubic
ramus.
~ii. The gracilis, chiefly from. the pubic ramus.
to fonn_the P 111
/abrum 1s attac11e
J~:
. . d ens the acetabular cav1 Y·
·t
acetnbu/nr
t.O the margin s of the acetabulun\'
,
1v. TI1e adducto r magnus, chiefly from the ischial it eep d . hium both form 2/Sth each of
ramus (Fig. 2.3). 6 Ilium an ipscb . only forms 1/Sth of acetabulun1.
acetabulum. u is
d. The attaclunents on the inner surface are as follows:
i. The perinea l membr ane is attache d to the
lower ridge (Fig. 2.4). OBTURATOR FORAMEN
. . 1.
ii. The upper area gives origin to the obturator 1 This 1s a ar ge ga p in hip bone,
.
lying anteroinferior
d · h·
internu s. to acetabulum, betwee n pubis an ilslc ltd1m._
iii. The middle area gives origin to the deep . 1arge an d oval in males and sma an triangular
2 It 1s '
transversus perinei, and is related to the dorsal in females (Fig. 2.1). . .
nerve of the penis clitoris, and to the internal 3 It is closed by the obturat or membr ane which 1s
pudend a! vessels (Fig. 2.4). attache d to its margin s, except at the obturator
iv. The lower area provides attachment to crus groove where the obturat or vessels and nerve pass
penis/ clitoris, and gives origin to the ischio- out of the pelvis (Fig. 2.2).
cavern osus and to superficial transve rsus
perinei (Fig. 2.4). OSSIFICATION
ACETABULUM • The hip bone ossifies in cartilag e from three
1 Acetab ulum is a deep cup-sha ped hemispherical primary centres and five seconda ry centres ...
cavity on the lateral aspect of the hip bone, about its • The primary centres appea~, one fo~ th 11mm
centre (Fig. 2.1). during the second month of mtraute nne hfe;7 one
2 It is directed laterally, downw ards and forwards. for the ischium during the fourth month; and one
3 The margin of the acetabulurn is deficient inf~riorly, for the pubis during the fifth month.
this deficiency is called the acetabular notch (Fig. 2.3). • At birth the hip bone is ossified except for three
It is bridged by the transverse ligame~t. cartilaginous parts. These are:
4 The non-art icular roughe ned floor 1s called the i. The iliac crest.
acetabular fossa. It contains a mass of fat which is lined ii. A Y-shap ed cartilag e separa ting the ilium,
by synovial membrane. ischium and pubis (Fig. 2.7).

@l,i,,,•,m,-11fii1W F:piphyseal line

. - -- ------ ===-- Secondary centre

Appearan ce-at puberty
Fusion-2 0th to 25th year

Primary centre (ilium)

Appearan ce-2nd month of JUL

1_,..---- Secondary centre

Appearan ce-at puberty
Primary centre (lschlum) Fusion-2 0th to 25th year
Appearan ce-4th month of IUL
Primary centre (pubis)
Appearan ce-5th month of JUL
secondary centre ----...
Appearan ce-at puberty Fusion of ischiopubic
Fusion-2 0th to 25th year rami at 7th-8th year

Fig. 2.7: Ossification of the hip bone

-- - - -- - - - - -- - - -- - - - - B-
ONES
-~ -
iii. A strip along the inferior margin of the bone
including the ischial tuberosity.
TI,c ischiopubic rami fuse with each other at 7th
to Slh year of age.
11,c secondary centres appear at puberty, two for
lhe iliac crest, two for the Y-shaped cartilage of the
acctabulum and one for the ischial tuberosity.
• Ossiiication in the acetabulum is complete at
16th-17th year, and the rest of the bone is ossified
by 20th-25th year.
• The anterior superior iliac spine, pubic tubercle and
crest and the symphyseal surface may have
separate secondary centres of ossification.
CLINICAL ANATOMY
• Iliac crest is used for taking bone marrow biopsy
in cases of anemia or leukemia.
• Weaver's bottom-pers ons sitting for a long
period of time may get inflammation of their
ischial tuberosity bursa.
FEMUR
The femur (Latin thigh) or thigh bone is the longest and
the strongest bone of the body. Like any other typical
bone (Figs 2.8 and 2.9). Femur has an upper rounded
end; a lower bicondylar end and a long shaft which is
convex forwards.
Side Determination
1 The upper end bears a rounded head whereas the
lower end is widely expanded to form two large
condyles.
2 The head is directed medially.
3 The cylindrical shaft is convex forwards.
Anatomical Position
1 The head is directed medially upwards and slightly
forwards.
2 The shaft is directed obliquely downwards and
medially so that the lower surfaces of two condyles
of femur lie in the same horizontal plane.
Upper End
The upper end of the femur includes the head, the neck,
th e greater trochanter (Greek runner) the lesser
trochanter, the intertrochant eric line, and the
intertrochanteric crest. These are described as follows.
Head
1 The head forms more than half a sphere, and is directed
medially, upwards and slightly forwards (Fig. 2.8).
15
2 It articulates with the acetabulum to form the hip
joint. .
3 A roughened pit is situated just below and behind
the centre of the head. This pit is called the fovea
(Fig. 2.9).
Neck
1 It connects the head with the shaft and is about
3.7 cm long.
2 The neck has two borders and two surfaces (Fig. 2.8).
The upper border, concave and horizontal, meets the
shaft at the greater trochanter. The lower border,
straight and oblique, meets the shaft near the lesser
trochanter.
The anterior surface is flat. It meets the shaft at the
intertrochanteric line. It is entirely intracapsular. The
articular cartilage of the head may extend to this
surface. The posterior surface is convex from above
downwards and concave from side to side. It meets
the shaft at the intertrochanteric crest (Fig. 2.9). Only
a little more than its medial half is intracapsular.
The posterior surface is crossed by a horizontal
groove for the tendon of the obturator extemus to
be inserted into the trochanteric fossa.
3 The neck makes an angle with the shaft. The neck-
shaft angle is about 125° in adults. It is less in females
due to their wider pelvis (Fig. 2.8). The angle
facilitates movements of the hip joint. It is
strengthened by a thickening of bone called the calcar
femorale present along its concavity.
4 Trochanter-shaft angle is about 8° in adults. It is an
important radiological parameter which provides the
idea of direction of medullary canal and its alignment
with the greater trochanter.
5 The angle offemoral torsion or angle of anteversion is
formed between the transverse axes of the upper and
lower ends of the femur. It is about 15°.
6 Blood supply: The intracapsular part of the neck is .D.
supplied by the retinacular arteries derived chiefly E
from the trochanteric anastomoses. The vessels ::i
produce longitudinal grooves and foramina directed ci,
towards the h ead, mainly on the anterior and ...J~
posterosuperior surfaces. The extracapsular part of
the neck is supplied by the ascending branch of the
medial circumflex femoral artery (Fig. 2.20a).
Greater Trochanter
1 This is a large quadrangular prominence located at
the upper part of the junction of neck with the shaft.
The upper border of the trochanter lies at the level
of the centre of the head (Fig. 2.8).
2 The greater trochanter has an upper border with an
apex, and three surfaces, anterior, medial and lateral.
The apex is the intumed posterior part of the upper
--
1
J 16 - LOWER LIMB _ _ _ _ _ _ _ _ _ __ _ _ __ _ _ _
----..:::.:.:.:..:_ ~

Upper border
of neck Tip orgrcaic,
trochanter
Hoad and neck - ~ -,c...-
Graater Greater
trochnnter lnlertrochanterlc---_, _-~ trochanter
lntertrochantoric crest
line
Lesser trochanter- - - -i- Ouadrale
Lesser trochanter • tubercle
Addltlonal - - -
posterior surface Lateral surfaee
Medial surface
Anterior surface Gluteal
of shaft Spiral line tuberosity

Medial border

Nutrient foramen ----;--,,,

Linea aspera ~ ...._,,.--t-1

with two lips

b
Medial
supracondylar
line

r;---Lateral
lntercondyl supracondylar
Adductor line and fos line
tubercle
"' ~
.'
Medial
epicondyle Adductor Popliteal surface
Lateral---+-
condyle
1
--Medial
tubercle
Lateral epicondyle
condyle
TTbial
surface Lateral condyle
Articular surface for patella
.0
E Fig. 2.8: Right femur-anterior aspect
Fig. 2.9: Right femur-posterior aspect
::J

border. The anterior surface is rough in its lateral part. ridge which begins ab th
The medial surface presents a rough impression above, of the greater troch t ove, at e anterosuperior angle
and a deep trochanteric fossa below. The lateral surface below with the an_ er as~ tubercle, and is continuous
is crossed by an oblique ridge directed downwards trochanter. The s i:~:~~l lu~e in front of the lesser
and forwards (Fig. 2.8). the lesser troch~t t me wmd s round the shaft below
the shaft. er O reach the posterior surface of
Lesser Trochanter
It is a conical eminence directed medially and lntertrochanteric Crest
backwards from the junction of the posteroinferior part It marks the junction of th 0st .
of the neck with the shaft. with the shaft of the fe e P er:1or surface of the neck
ridge which b . b mur. It is a smooth-rounded
' egms a ove t th
Jntertrochanteric Line of the greater tr h a e posterosuperior angle
It marks the junction of the anterior surface of the neck tr~chant~r. The ro:;e~:r an~ ends _at the less_er
\>vi.th the shaft of the femur. It is a prominent roughened ffilddle, 1s called the d levation, a httle above its
qua rate tubercle (Fig. 2.9).
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ __:_.
BO:,_N_ES_ __ .
Shatt
TI1e shaft is more or less cylindrical. It is narrowest in
the m~ddle, an_d is more expanded inferiorly than
supenorly . It 1s convex forwards and is directed
obliquely downwards and medially, because the upper
ends of two femora are separated by the width of the
pelvis, and their lower ends are close together.
In the middle 011e-tliird, the shaft has three borders-
medial, lateral and posterior and three surfaces-
anterior, medial and lateral.
The medial and lateral borders are rounded and
ill-defined, but the posterior border is in the form of
a broad roughened ridge, called the linea aspera
(Latin rough line). The linea aspera has distinct medial
and lateral lips.
The medial and lateral surfaces are directed more
backwards than towards the sides.
In the upper one-third of the shaft, the two lips of the
linea aspera diverge to enclose an additional posterior
surface. Thus this part has:
Four borders-m edial, lateral, spiral line and the
lateral lip of the gluteal tuberosity (Fig. 2.9)
Four surfaces-a nterior, medial, lateral and
posterior. The gluteal tuberosity is a broad roughened
ridge on the lateral part of the posterior surface.
In the lower one-third of the shaft also, the two lips of
the linea aspera diverge as supracondy lar lines to
enclose an additional, popliteal surface (Fig. 2.9). Thus,
this part of the shaft has:
Four borders-m edial, lateral, medial supracondylar
line and lateral supracondy lar line.
Four surfaces- anterior, medial, lateral and
popliteal. The medial border and medial supracondy lar
line meet inferiorly to obliterate the medial surface.
Similarly the lateral border and lateral supracondy lar
line also meet inferiorly to obliterate the lateral surface.
Lower End
The lower end of the femur is widely expanded to form
two large condyles, one medial and one lateral. These
form articular surface for the knee joint. Anteriorly, the
two condyles are united and are in line with the front
of the shaft. Posteriorly, they are separated by a deep
gap, termed the intercondylar fossa or intercondy lar
notch, and project backwards much beyond the plane
of the popliteal surface (Fig. 2.9).
Articular Surface
The two condyles are partially covered by a large
articular surface which is divisible into patellar and
tibial parts.
The articular surface for patella covers the anterior
surfaces of both condyles, and extends more on the
. l (Fi 2.8). Between
J.1teral condyle than on the media ~-vertically . [tis
the two condyles, th~ ~urface is groo:., faint grooves.
separated from the tibial surfaces by 0 t ·or
· ferior and pos en
The tibial surfaces cover t h e m . 1 with
surfaces of the two condyles, and merge anterior Y the
the patellar surface. The part of the surface ~ve_r rl
lateral condyle is short and strai?ht anteropo~ enovfci
The part over the medial condyle_1s long~r and 1s cur
with its convexity directed medially (Pig. 2.9).
Lateral Condyle
The lateral condyle is flat laterally, and is more i_n line
with the shaft. It therefore, takes greater part m the
transmission of body weight to the tibia. Though it is
less prominent than the medial condyle, it is stouter
and stronger. The lateral aspect presents the following.
1 A prominence called the lateral epicondyle.
2 The popliteal groove which lies just below the
epicondyle. It has a deeper anterior part and a
shallower posterior part.
3 A muscular impression posterosu perior to the
epicondyle.
Medial Condyle
This condyle is convex medially (Fig. 2.10). The most
prominent point on it is called the medial epicondyle.
Posterosuperior to the epicondyle there is a projection,
the adductor tubercle . This tubercle is an important
landmark. The epiphyseal line for the lower end of the
femur passes through it.
lntercondy/ar Fossa or lntercondylar Notch
This notch separates the lower and posterior p arts of
the two condyles. lt is limited anteriorly by the patellar
articular surface, and posteriorly by the intercondyl ar
line which separates the notch from the popliteal
surface.
Attachments on the Femur .C
1 The fovea on the head of the femur (Fig. 2.11) :::i E
provides attachment to the ligament of the head of a;
femur or round ligament, or ligamentum teres / ~
femoris (Fig. 2.12a). ,9
2 The following are attached to the greater trochanter.
a. The piriformis is inserted into the apex (Fig. 2.12a).
b. The gluteus minimus is inserted into the rough
lateral part of the anterior surface (Fig. 2.10).
c. The obturator internus and the two gemelli are
inserted into the upper rough impression on
medial surface (Fig. 2.11).
d. The obturator externus is inserted into the
trochanteric fossa (Fig. 2.12a) .
e. The gluteus medius is inserted into the ridge on
the lateral surface (Fig. 2.12b). The trochanteri c
...-;:-
. -L_ ~ lO~W~f~1<~U:!!M~a~- - - - - - - - - - - - -- - - -- - - -- - - - - - ~

Gluteus medius

tc-~='--,:S
Obturator
internus and
·~~ two gemelli
~

\·~ _ _,,,, Capsular fig.arnent '----<<---- Quadra tus

femoris
\;;'?.-~
...___ _ _ Psoas rnaJOr ---'4---- Gluteus
maximus

■1.11J---- Vastus
Vastu:5 ------ - - vastus medialis lateralis
~ ..,....~'uS
1111-- - - Vastus
intermedius

/.j,1111 - - - - - - Short head of

biceps femoris

4+-!!"---- ~ - Lips of
linea aspera

- - - - Lateral surface

~ - - - Articularis genu
~ - - Gastrocnemius
(medial head)

Capsular ligament
.,......_ _ __ Plantaris

,._~ - Adductor magnus --:-le~~- _,-_~~ - - - Gastrocnemius

(lateral head)

Medial condyle Posterior -1-----

cruciate " - - - - Anterior
ligament cruciate ligament
Flg. 2.1O: Attachments on the anterior aspect of the right femur Fig. 2.11 : Attachments on the posterior aspect of the right femur

bu rsa of the gluteus maximus lies behind the
ridge.
3 The attachmen ts on the lesser trochanter are as follows:
a. The p!>Oas (G reek loin) ma jor is inser~ed on the
apex and medial part of the rough anterior surface
(Fig. 2.10).
b. The iliacus is inserted on the anterior surface ~f
the base of the trocha nter and on the area below it
(Figs 2.11 and 2.13).
c. The smooth posterior s urfa ce of ~he lesser
trochanter is covered by a bursn that lies deep to
the upper horizontal fibres of the adductor ma gnus.
4 The intertrochanteric line provides:
a• Attachment to the capsular ligament of the hip joint.
b. Attachment to the upper band of the iliofemoral
ligament in its upper part (Fig. 2.12a).
c. Attachme nt to the lower band of iliofemoral
lig~1:1ent in its lower part (Fig. 2.14).
d. Ongm to the highest fibres of the vastus lateralis
fro_m, the upper end (Fig. 2.1 2b).
e. Ongm to the highest fibres of the vastus medialis
, . from th e lower end of the line (Fig. 2.12a).
5 1he qllndmte t11bcrcle receives
the insertion of the
quadra tus femoris (Fig. 2.11).
- - - - - - - - - - -- - - - - - BONE
-~ S 1- 19

Fo vp9

Ll!),lm£.<n!um Obluralor infernus

!r-morts
IN!:'SI and lwo gemolli
Obluralor externus
Uo!X'r and lower baf'ds of __,..,___ Gluteus minimus
ihc,fpmoral hgamenl Quadratus femoris medius
- - Psoas major Vastus lateralis
lliacus

Gluleus maximus _ __, Vastus intermedius

Va;,tus inlermedrus - --
,_,__ __ Vaslus medialls

(a) (b)
Figs 2.12a and b: Upper end of the right femur: (a) Medial aspect, and (b) lateral aspect

6 The a ttachments on the shaft are as follows: 1. The short head of the biceps femoris arises from
a. The medial and popliteal surfaces are bare, except the lateral lip of the linea aspera between the
for a little extension of the origin of the medial vastus lateralis and the adductor magnus, an d
head of the gastrocnemius to the medial part of from the upper two-thirds of the latera l
popliteal surface. supracondylar line (Fig. 2.13).
b. The vastus intermed ius arises from the upper m.The medial and lateral intermuscular septa are
three-fourths of the anterior and lateral surfaces attached to the lips of the linea aspera and to the
(Fig. 2.10). supracondylar lines. They separate the extensor
c. The articularis genu arises just below the vastus muscles from the adductors medially, and from
intermedius (Fig. 2.10). the flexors laterally (see Fig. 3.9).
d . The lower 5 cm of the anterior surface are related n. The lower end of the lateral supracondylar line
to suprapatellar bllrsn. gives origin to the plantaris above and the upper
e. The vastus lateralis arises from the upper part of part of the lateral head of the gastrocnemius below
the intertrochanteric line, anterior and inferior (Fig. 2.11).
aspects of the greater trochanter, the lateral margin
of the gluteal tuberosity, and the upper half of the lliacus
la teral lip of the linea aspera (Figs 2.12b and 2.13). Gluteus maximus
Pectineus
f. The vastus medialis arises from the lower part of Vastus lateralis
intertrochanteric line, the spiral line, medial lip of Vastus
the linea aspera, and the media l supracondylar medialls Vastus intermedlus
line (Fig. 2.13). Adductor
brevls Short head or biceps
g. 'Ine deeper fibres of the lower half of the gluteus lemoris
.0
maxim us are inserted into the gluteal tuberosit'y. Adductor
E
::::i
h. The ad ductor longus is inserted along the medial longus Lateral lntermuscular
seplum
...
(1)
lip of the linea aspera between the vastus medialis ~
Adduclor
and the adductors brevis and magnus. magnus - - Posterior 0
...I
1. The adductor brevis is inserted into a line extending lnlermuscular septum
from the lesser trnchanter to the upper part of the Medial
lntormuscular
linca c1spcra, behind the pcct-incus and the upper septum
part of the adductor long us (Fig. 2.13).
j. The add uctor magnus is inserted into the medial
margin of the glutea l tuberusity, the linen aspern,
the mt:diill suprncondylar line, nnd the nclductor
tubercle, leaving n gap/opening for the popliteal
Opo11l11g lor
vessels (Fig. 2.11). poplltool
k. The pectincus is inserted on n line extending from vossols
the lesser trochnnler lo the linen nspera. Fig. 2.13: Magnified view of structures attached to linea aspera
 LOWER LIMB
20

. cruciate liaarnent is attached to the

b. The P?stenort f the lateral surface of medial
O
an tenor par th impression (Fig. 2.11).
,,--- - - Pubofemoral condyle, on a smoo "d tt chm t
ligament . di lar line prov1 es a a en to the
lliofemoral - ~ - c. The mterc?n Y (fia 2.11) and laterally to th
ligament capsular ligament. o· e
Pubic obli ue popliteal ligament. .
symphysis q_ ,(.,. tellar synovial fold 1s attached to the
d. The ,_n1,abpad 0 f the intercondylar fossa.
antenor or er
Nutrient Artery to the Femur .
. . d . d fr Om the second perforating artery,
f
branch
'-+--- lntertrochanteric line This 1s enve ·
of rofunda femoris artery. The n_utr1ent oramen is
Fig. 2.14: Attachment of iliofemoral ligament
loc~ted on the medial side of the hnea aspera, and is
directed upwards (Fig. 2. 9).
o. The popliteal surface is covered with fat and forms
the floor of the popliteal fossa. The origin of the Structure
medial head of the gastrocnernius extends to the The angles and curvatures of the femur are strengthen~d
popliteal surface just above the medial condyle on their concave sides by bony buttresses. The c~ncaVIty
(Fig. 2.11). of the neck-shaft angle is strengthened by a thickened
7 ·The attachments on the lateral condyle are: buttress of compact bone, known as the calcar femorale.
a. The fibular collateral ligament of the knee joint is Similarly, the linea aspera is also s1:1ppor~e~ by another
attached to the lateral epicondyle (Fig. 2.15). buttress. This mechanism helps m resisting stresses
b. The popliteus arises from the deep anterior part including that of body weight.
of the popliteal groove. When the knee is flexed
Competency achievement: The student should be able to:
the tendon of this muscle lies in the shallow
AN 14.3 Describe the importance of ossification of lower end of
posterior part of the groove. 3
femur and upper end of tibia.
c. The muscular impression near the lateral
epicondyle gives origin to the lateral head of the
gastrocnernius (Fig. 2.15). OSSIFICATION
8 The attachments on the medial condyle are as follows:
a. The tibial collateral ligament of the knee joint is • The femur ossifies from one primary and four
attached to the medial epicondyle (see Fig. 12.1 la). secondary centres.
b. The adductor tubercle receives the insertion of the • The primary centre for the shaft appears in the
hamstring part or the ischial head of the adductor seventh week of intrauterine life (IUL). The
magnus (Fig. 2.10). secondary centres appear, one for the lower end
9 The attachments on the intercondylar notch are as follows: at the end of the ninth month of intrauterine life,
a. The anterior cruciate ligament is attached to the one for the head during the first six months of life,
posterior part of the medial surface of the lateral one for the greater trochanter during the fourth
condyle, on a smooth impression. year, and one for the lesser trochanter during the
twelfth year (Fig. 2.16).
• There ~e thr~e epiphyses at the upper end and
Superior on_e epiphys1s at the lower end. The upper
Posterior + Anterior epiph~ses; lesser trochanter, greater trochanter and
h~ad, m that order, fuse with the shaft at about
Inferior
e1ghte_en years. The lower epiphysis fuses by the
twentieth year.
Lateral head o f -- ~ ~e following points are noteworthy.
gastrocnemius Capsular
ligament
· bThe nee~ represents the upper end of the shaft
Fibular collateral -1---'--.• ecause 1t oss1"fi es fr om the primary centre.
..
2. Ossification f the 1ower end of the femur is of
ligament on
lateral epicondyle ---- -r:.-- Popliteus . °
me d 1co1egal importance.
·
in popliteal . Presence of its centre
Groove for tendon groove manewlybom hildf
of popliteus the child was c . ound dead indicates tha:
Fig. 2.15: Attachments on the lateral surface of the lateral condyle independ ~iable, i.e. it was capable ot
ent existence.
of the femur
- - - - -- - - -- - - - - - - - - - - - - - - -~::BONES
.:::.::-
-
__, 21

IUL: Intrauterine life

=== Epiphyseal line

Secondary centre
Second ary centre - ...,.....,.,,,,,, Appeara nce-1st year
Appeara nce-4th year Fusion- 18th year
Fusion- 18th year 7_.c;..._ _ _ >60 years

Secondary centre
Appearance-12th year
Fusion- 18th year

r.t- -- Primary centre

Appeara nce-
7th week of IUL

- - - - <16year s

-~--+- Secondary centre

Appeara nce-
9th month of IUL
Fusion- 20th year
Fig. 2.16: Ossification of femur

3. The lower end of the femur is the growing end.

4. The lower epiphyseal line passes through the
adduc tor tubercle. Fig. 2.17: Common sites of fracture
5. The epiphyseal line of the head coincides with
the articular margins, except superiorly where
a part of the non-articular area is included in
the epiphysis for passage of blood vessels to
the head. In additi on, the plane of this
epiphysis changes with age from an oblique to
a more vertical one.

CLINICAL ANATOMY
• Tripp ing over minor obstru ctions or other
accide nts causin g forced media l rotation of the
thigh and leg during the fall results in:
a. The fracture of the shaft of femur in persons
below the age of 16 years (Fig. 2.17).
b. Bucke t-hand le tear of the media l menis cus
betwe en the ages of 14 and 40 years (Fig. 2.18).
c. Pott' s (British surgeo n, 1713-88) fracture of the
leg bones betwe en the ages of 40 and 60 years
(Fig. 2.19).
d. Fractu re of neck of the femur over the age of
60 years . This is comm on in females due to
osteo poros is and degen eratio n of calcar
femorale.
.c
E
~
Fig. 2.18: Bucket-handle tear of medial meniscus
• The head of femur is partly supplied by a branch
of obturator artery along the ligamentum teres.
Main arterial supply is from retinacular arteries,
branch es of media l circumflex femoral artery.
These arteries get injured in intracapsular fracture
of neck of femur, leading to avascular necrosis of
the head (Figs 2.20a and b).
• The centre of ossification in lower end of femur and
even in upper end of tibia seen by X-ray is used as
a medicolegal evidence to prove that the newborn
(found dead) was nearly full term and was viable.