ANATOMY OF THE FEMUR

Priadinda Tri Utama

ORTHOPAEDICS AND TRAUMATOLOGY DEPARTMENT

SEBELAS MARET UNIVERSITY
Dr. MOEWARDI GENERAL HOSPITAL / Prof. Dr. R. SOEHARSO ORTOPEDI HOSPITAL
SURAKARTA
2022
 OSTEOLOGY

Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
Long bone characteristics
Proximal femur
• Head: nearly spherical (2/3)
• Neck: anteverted from shaft
• (Neck/shaft angle: 120-135°)
• (Femoral anteversion: 10-15°)
• Greater trochanter: lateral
• Lesser trochanter: posteromedial
Shaft: tubular, bows anteriorly
• Linea aspera posterior: insertion of fascia and muscles
Distal femur: 2 condyles
• Medial: larger, more posterior
• Lateral: more anterior & proximal
• Trochlea: anterior articular depression between condyles
 CLINICAL CORRELATION

ANATOMICAL AXIS
Line drawn along the axis of the femur
MECHANICAL AXIS
Line drawn between center of femoral head and
intercondylar notch
KNEE AXIS
Line drawn along the inferior aspect of both
femoral condyles
VERTICAL AXIS
Vertical line, perpendicular to the ground

Blom, A., Warwick, D., & Whitehouse, M. (Eds.). (2017). Apley & solomon's system of orthopaedics and trauma. CRC Press.
Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
MUSCLE - anterior
 MUSCLE ORIGIN INSERTION NERVE ACTION
ANTERIOR
RECTUS FEMORIS 1. AIIS Patella/tibial Femoral Flex thigh,
extend
2. Sup. acetab. Tubercle
rim Leg

VASTUS LATERALIS Gtr. Lateral patella/ Femoral Extend leg

trochanter, lat.
tibia tubercle
linea aspera

VASTUS INTER Proximal Patella/tibia Femoral Extend leg

MEDIUS femoral
tubercle
Shaft

VASTUS LATERALIS Intertrochant. Medial patella/ Femoral Extend leg

line,
tibia tubercle
med. linea
aspera

Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
 MUSCLE ORIGIN INSERTION NERVE ACTION
MEDIAL
HIP ADDUCTOR
Adductor Body of pubis Linea aspera Obturator Adducts thigh
Longus (inferior) (mid 1⁄3)
Adductor Body and Pectineal line, Obturator Adducts thigh
inferior
Brevis linea aspera
pubic ramus
Adductor 1. Pubic ramus Linea aspera, 1. Obturator Adducts & flex/
Magnus 2. Ischial tub. add. tubercle 2. Sciatic extend thigh
Gracilis Body and Prox. med. tibia Obturator Adduct thigh,
inferior
(pes an serinus) flex/IR leg
pubic ramus
HIP FLEXOR
Pectineus Pectineal line Pectineal line of Femoral Flex and adducts
of pubis
femur thigh
 MUSCLE – posterior

Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
 MUSCLE ORIGIN INSERTION NERVE ACTION
POSTERIOR: HAMSTRINGS
Semitendinosus Ischial Proximal medial Sciatic Extend thigh, flex
tuberosity leg
tibia (pes (tibial)
anserinus)
Semimembranosus Ischial Posterior medial Sciatic Extend thigh, flex
tuberosity leg
tibial condyle (tibial)
Biceps femoris: Ischial Head of fi bula Sciatic Extend thigh, flex
tuberosity leg
long head (tibial)
Biceps femoris Linea aspera, Fibula, lateral Sciatic Extend thigh, flex
leg
supracondylar tibia (peroneal)
line
 ORIGINS - INSERTIONS

Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
 COMPARTMENT

Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
 VASCULARIZATION
Artery Abdominal
Aorta

External Iliac
Artery

Femoral Artery

Profunda
Femoris Artery

Lateral Medial
Perforating
Circumflexa Circumflexa
Artery
Femoral Artery Femoral Artery

Moore, K. L., Agur, A. M. R., & Dalley, A. F. (2018). Clinically oriented anatomy (Eighth edition). Wolters Kluwer.
 VASCULARIZATION
Vein

Profunda
Femoris Vein

Femoral Vein

c
Great
Saphenous
Vein

c
Moore, K. L., Agur, A. M. R., & Dalley, A. F. (2018). Clinically oriented anatomy (Eighth edition). Wolters Kluwer.
 Blood supply to bone

Tulang baru berkembang ke luar dengan

osifikasi langsung pada lapisan terdalam
periosteum di mana sel-sel mesenkim
berdiferensiasi menjadi osteoblas
(pembentukan tulang intramembran, atau
'aposisional') dan tulang tua dikeluarkan dari
bagian dalam silinder oleh resorpsi endosteal
osteoklastik.

Blom, A., Warwick, D., & Whitehouse, M. (Eds.). (2017). Apley & solomon's system of orthopaedics and trauma. CRC Press.
Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
 INNERVATION

Lumbar Plexus
Lateral Femoral
Cutaneous Nerve

Femoral Nerve

Sacral Plexus
Tibial Nerve
c
Common
Sciatic Nerve
Peroneal Nerve
Posterior Femoral
Cutaneous Nerve
c

Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
 RADIOLOGY

Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
 Hip Dislocation usually because high-energy
trauma (esp. MVA, dashboard injury) or
signifi cant fall. This injury counted as one of
orthopaedic emergency; risk of femoral head
AVN increases with late/delayed reduction.

Hip dislocation commonly associated with multiple

injuries / fractures (e.g., femoral head/neck, acetabulum).
Posterior dislocation is the most common type (85%).

Moore, K. L., Agur, A. M. R., & Dalley, A. F. (2018). Clinically oriented anatomy (Eighth edition). Wolters Kluwer.
Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
 Femoral Neck Fracture CLINICAL CORRELATION

MoI : most common due to fall by elderly person or high-energy

injury in young adults (e.g., MVA). This fracture is an intracapsular
fractures. Femoral head vascularity at risk in displaced fractures.
Associated with osteoporosis. High morbidity & complication rates

MoI : most common due to fall by an elderly person. Associated

with osteoporosis. Occurs along or below intertrochanteric line.
This fracture caunted as an extracapsular fractures. Stable
vascularity. Most heal well with proper fixation

Moore, K. L., Agur, A. M. R., & Dalley, A. F. (2018). Clinically oriented anatomy (Eighth edition). Wolters Kluwer.
Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
 Garden classification of femoral neck fractures
(a) Stage I: incomplete (so-called
abducted or impacted hip fracture) – the
femoral head in this case is in slight
valgus.
(b) Stage II: complete without
displacement.
(c) Stage III: complete with partial
displacement – the fragments are still
connected by the posterior retinacular
attachment; the femoral head trabeculae
are no longer in line with those of the
innominate bone.
(d) Stage IV: complete with full
displacement – the proximal fragment
is free and lies correctly in the
acetabulum so that the trabeculae
appear normally aligned with those of
the innominate bone.

Blom, A., Warwick, D., & Whitehouse, M. (Eds.). (2017). Apley & solomon's system of orthopaedics and trauma. CRC Press.
 Intertrochanteric fractures – Kyle classification

• Types 1 to 4 are arranged in increasing degrees of instability and complexity. Types 1 and
2 account for the majority (nearly 60%).
• The reverse oblique type of intertrochanteric fracture represents a subgroup of type 4; it
causes similar difficulties with fixation.
Blom, A., Warwick, D., & Whitehouse, M. (Eds.). (2017). Apley & solomon's system of orthopaedics and trauma. CRC Press.
 Subtrochanteric fractures of the femur – warning signs on the X-ray

X-ray findings that

should caution the
surgeon:
(a) Comminution, with
extension into the
piriform fossa;
(b) Displacement of a
medial fragment
including the lesser
trochanter; and
(c) Lytic lesions in the
femur.

Blom, A., Warwick, D., & Whitehouse, M. (Eds.). (2017). Apley & solomon's system of orthopaedics and trauma. CRC Press.
 CLINICAL CORRELATION
This is an orthopaedic emergency. MoI : high-energy injury
(e.g., MVA, fall). Commonly appear as an associated injuries. 1. there is only a tiny
Potential source of significant blood loss and compartment cortical fragment.
syndrome can occur  transport patient in traction
2. In type 2 the ‘butterfly
fragment’ is larger but
there is still at least 50%
cortical contact between
the main fragments.
3. In type 3 the butterfly
fragment involves more
than 50% of the bone
width.
4. Type 4 is essentially a
segmental fracture.

Moore, K. L., Agur, A. M. R., & Dalley, A. F. (2018). Clinically oriented anatomy (Eighth edition). Wolters Kluwer.
Thompson, J. C. (2016). Netter’s concise orthopaedic anatomy (Second edition, updated edition). Saunders Elsevier.
 The AO classification of supracondylar fractures

(a) Type A fractures do not

involve the joint surface
(b) type B fractures involve the
joint surface (one condyle)
but leave the supracondylar
region intact
(c) type C fractures have
supracondylar and condylar
components.

Blom, A., Warwick, D., & Whitehouse, M. (Eds.). (2017). Apley & solomon's system of orthopaedics and trauma. CRC Press.
THANK YOU
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