07 Appendicular Skeleton Pelvic Girdle And Lower Limbs

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  • 1. Thelowerportion of the appendicular skeleton consists of thepelvic girdleand thelower extremities .

2. According toyour text , the termpelvic girdlerefers only to the left and right ossa coxae (each of which is composed of the ilium, ischium, and pubis).However, some texts also include the sacrum. Ilium Iliac crest Acetabulum 3. Thepelvisconsists of the two ossa coxae (singular = os coxae), the sacrum, and the coccyx. 4. The pelvic girdleprotectsand supportsseveral abdominal organs 5. Eachos coxaeconsist of three bones fused together Acetabulum 6. Eachos coxae(hip bone) consists of the ilium, ischium, and pubis.These three bones fuse between 13-15 years of age. Acetabulum 7. Theiliumis the largest and uppermost of the pelvic bones 8. Theauricular surfaceis the portion of the ilium that articulates with the sacrum 9. Theiliac crestterminates anteriorly at theanterior superior iliac spine . 10. 11. This person is actually pressing on theanterior superior iliac spine . 12. Theiliac crestterminates posteriorly at theposterior superior iliac spine 13. 14. 15. Bone marrow biopsyin posterior portion of the iliac crest 16. Theischiumis the posterior-inferior component of the os coxae.It is the portion of the pelvis we sit on. 17. Note theischial tuberosityof the ischium on which we sit. 18. 19. Thepubisis the anterior component of the os coxae. 20. 21. 22. WHAT PORTION OF YOUR PELVIS ISMOST PROXIMALTO YOUR BELT? A COCCYX B SACRUM C ILIUM D ISCHIUM E PUBIS 23. Thefalse pelvis(shown in green) is the upper portion of the pelvic basin and is enclosed by the wing-like sides of the flared iliac bones. 24. Thetrue pelvis(shown in pink) is the lower portion of the pelvic basin and it encloses the pelvic cavity and forms a deep narrower region that contains the pelvic organs. 25. During birth (parturition) the fetus passes through thetrue pelvisduring a normal vaginal delivery 26. Pelvimetry is the measurement of the size/shape of thepelvic outlet Inferior view 27. Fetus headready to pass through the true pelvis and pelvic outlet during birth 28. 29. Are you comfortable and relaxed? 30. The old ways are sometimes the best 31. Thesquatting positioncan increase the diameter of the true pelvis 32.

  • In our society we are not used to squatting, and it can be a difficult position to assume.
  • You can practice!

33. Birth (parturition) in the squatting position with support from partner. 34. Supported squatting position for childbirth 35. During pregnancy there is a special hormone calledrelaxinthat is released by thecorpus luteumof the ovary 36. Relaxinloosens thesymphysis pubisand thesacroiliac jointto increase the diameter of the true pelvis and pelvic outlet to facilitate parturition. 37. Male Female Note the female pelvis has wider flair of iliac crests, has a more spherical true pelvis, and the pubic arch is wider than the male 38. Articular surface ofpubic bonesat symphysis pubis 39. Articular surface ofpubic bonesat symphysis pubis 40. Thefemuris the only bone of the thigh.However, we will also discuss the patella.The femur is the strongest bone in the body. It is a useful study technique tocompare and contrastthe bones of the lower extremity with their counterparts in the upper extremity. 41. The proximal roundedheadof the femur articulates with the acetabulum of the os coxae.Below the head is a constrictedneckthat is a common site for fractures of the femur in elderly persons. 42. A tiny ligament connects the acetabulum to thefoveain the proximal head of the femur 43. shaft The constrictedneckjoins theshaftof the femur.. 44. Theshaft of the femur has a slight medial bowto bring the knee joints more in line with the bodys plane of gravity.This degree of convergence is more pronounced in females. 45. Because of a females wider hips the medial bow of the femur is more noticeable and the knees are in closer proximity to each other. 46. It is technicallyincorrectto say that an elderly person, usually a female, has broken her hip.It is more accurate to state that they broke theneck of their femur . 47. Thegreater trochanter , which develops because of pulling stress on the periosteum, is found on the proximal lateral portion of the femur. 48. Features of thefemur 49. Thepatellais a sesamoid bone positioned on the anterior surface of the femur.It does NOT articulate with the tibia. 50. Patellaon femur 51. Note largest facet is lateral when apex is inferior. 52. WHICH OF THE FOLLOWING DOESNOTARTICULATE WITH THE FEMUR? A TIBIAL TUBEROSITY B PUBIS C SESAMOID BONE D ILIUM E ISCHIUM 53. Thelower leg , or crural region, contains two bones: thetibia , which is a weight-bearing bone, and thefibula , which not a weight-bearing bone but is important for muscle attachment. posterior anterior 54. Interosseous membrane 55. Thetibiais the larger and more medial of the two bones of the crural region.At itsproximal endthe tibia articulates with the femur.At itsdistal endthe tibia articulates with the talus. 56. Theintercondylar eminenceof the tibia is just a small stabilizing bump in the center of the tibial plateau. Themedial and lateral condyles of the tibiaarticulate with the medial and lateral condyles of the distal femur. Anterior Posterior 57. Anterior view The fibula and the tibia at their proximal ends form thesuperior tibiofibular joint 58. Thetibial tuberosityof the tibia is the distal attachment site of the patellar ligament. 59. About one fingers width below the tibial tuberosity, and just medial, is a flat surface on the anterior proximal portion of the tibiawhere interosseous infusions of life-saving fluids can be administeredby punching a large needle through the bone into the medullary cavity.This is easiest in children under five years of age. 60. Aninterosseous infusion needleused for punching through bone 61. Interosseous infusion 62. Interosseous infusion of life-saving fluidworks best in children under five years of age .Unlike veins, which may collapse when blood pressure falls, the medullary cavity of the tibia ALWAYS stays open. 63. Theanterior crest of the tibiacan be easily palpated.Themedial malleolusis at the distal end of the tibia and forms a medial knob that is also easily palpated.It is erroneously referred to as an ankle bone. Anterior Posterior 64. A child receiving life-saving fluid via interosseous infusioninto the medial malleolusof the tibia.As was stated previously, such I.O. infusions work best in children under five years of age. 65. for interosseous (I.O.) infusion of life-saving fluids So both the proximal AND distal ends of the tibia can be used for I.O. infusions. 66. The inferior portions of the tibia and fibula articulate to form theinferior tibiofibular joint 67. Thefibuladoesnotarticulate with the femur but it does with the talus. The distal end of the fibula forms thelateral malleolus,which is easily palpated on the lateral side of the ankle.It is erroneously referred to as an ankle bone. 68. 69. There are seventarsal bonesthat contribute to the ankle.We will only discuss two of these.Thetalusis the most superior of the tarsal bones and it articulates with the malleoli of the tibia and fibula.Thecalcaneusforms the prominence of the heel. 70. Thecalcaneusforms the prominence of the heel.It also serves as an attachment site for large calf muscles. 71. The foot containsfive metatarsal bones,with #1 leading to the great toe.All of the toes (digits) containthree bones , except for the great toe (digit #1), that only containstwo.These bones in the toes are calledphalanges . 72. There are three arches that support the weight of the body and provide leverage when walking:transverse arch, medial longitudinal arch, and lateral longitudinal arch . 73. The ligamentousmedial and lateral longitudinal archesand thetransverse archof the foot are maintained primarily by the foot bones themselves. 74. Talipes or clubfootis a congenital malformation in which the sole of the foot is twisted medially.Read about other foot pathologies in the clinical view in the text. 75. ACCORDING TO THE CLINICAL VIEW IN YOUR TEXT ON PATHOLOGIES OF THE FOOT,WHICH OF THE FOLLOWING CONDITIONSIS OFTEN SEEN IN PERSONS WITHPOLIOMYELITIS ? A PES PLANUS B TALIPES EQUINOVARUS C PES CAVUS D METATARSAL STRESS FRACTURE E CLUBFOOT 76. Fracture of the pelvis in a childcaused by blunt trauma.Open or closed fractures of the pelvis are associated with the risk of life-threatening blood loss. 77. Indirect forces can fracture the pelvis 78. Closed fractures of the pelvis may occur in elderly persons who suffer from osteoporosis. 79. Since it is a complete circle, stress to the pelvis usually results in fractures intwo placeswhen stress is applied. 80. Fractures of the pelvis can be associated withlife-threatening blood loss. Umbilicus Bleeding into tissues 81. Rapidly restoration of normal anatomy to control pelvic fracture bleeding is essential. 82. What many persons refer to as a hip fracture isactually a fracture of the neck of the femur . 83. Fractures of the neck of the femur most commonly occur in elderly post-menopausal females with osteoporosis. 84. Risk-taking young adults can also fracture the neck of the femur in traumatic accidents. 85. Teenage male slipped on ice and suffered break in neck of femur 86. Repair of the teenage males femoral neck fracture with stabilizing screws. 87. Risk-takingmalesnowboarderschest X-rayafter fracture of his femoral neck. Diaphragm Heart ? 88. Fracture of the neck of the femur in risk-taking male snowboarder. 89. This has to be painful! 90. His repair with a screwed on plate to the femoral shaft with an attached screw into the femoral neck. 91. Close-up of screw into femoral neck and head 92. Severetrauma is needed tofracture the femoral shaftin young adults. 93. Since severe trauma is needed to fracture the massive femur in young a