Osteology

Dr.Kumar Satish Ravi

M.B.B.S.,M.D.(JIPMER)
:Please take out the following bones

Hip Bone
The Foot

Femur Tibia & Fibula

Patella
 The Pelvic Girdle

Sacrum
Hip Bone Sacrum
Os Coxa Hip Bone
Os Coxa

2 hip bones
& sacrum
 The Hip Bone
• At birth 3 separate
Ilium
bones that fuse at
puberty.

• Ilium
Pubis • Ischium
Ischium • Pubis

Acetabulum
Acetabular Notch
• The skeleton of LL (Inf. appendicular skeleton)
divided into 2 functional components: the pelvic
girdle & the bones of the free lower limb .

• The pelvic girdle: Bony pelvis composed of the

sacrum and right & left hip bones joined
anteriorly at the pubic symphysis.

• It attaches the free LL to the axial skeleton, the

sacrum being common to the axial skeleton &
the pelvic girdle.
Arrangement of Lower Limb Bones
Hip Bone
• Hip bone(L. os coxae),
innominate (unnamed)
bone, large, flat pelvic
bone formed by the
fusion of three primary
bones ilium, ischium, and
pubis .
• At puberty, the 3 bones
are still separated by a Y-
shaped triradiate
cartilage centered in the
acetabulum.
Ilium
The ilium,largest part of the hip bone & contributes the superior
part of the acetabulum.
The body of the ilium joins the pubis & ischium to form the
acetabulum.

Anterior superior and anterior inferior iliac spines.

The iliac crest, extends posteriorly, terminating at the posterior

superior iliac spine (PSIS).

A prominence on the external lip of the crest, the tubercle of the

iliac crest , iliac tubercle, lies 5-6 cm posterior to the ASIS.

The posterior inferior iliac spine marks the superior end of the
greater sciatic notch.
• The lateral surface of the ala of the ilium has
three rough curved lines posterior, anterior,
and inferior gluteal lines that demarcate the
proximal attachments of the three large
gluteal muscles (glutei).
• Medially, each ala has a large, smooth
depression, the iliac fossa , that provides
proximal attachment for the iliac muscle (L.
iliacus).
• Posteriorly, the medial aspect of the ilium has
a rough, ear-shaped articular area called the
auricular surface (L. auricula, a little ear).
Ischium
• The ischium forms the posteroinferior part
of the hip bone.
• The ramus of the ischium joins the inferior
ramus of the pubis to form a bar of bone,
the ischiopubic ramus, which constitutes
the inferomedial boundary of the
obturator foramen. The posterior border
of the ischium forms the inferior margin of
a deep indentation called the greater
sciatic notch.
• The large, triangular ischial spine at the
inferior margin of this notch provides
ligamentous attachment.
• The rough bony projection at the junction
of the inferior end of the body of the
ischium and its ramus is the large ischial
tuberosity.
Pubis
• The pubis is divided into a flattened body and
two rami, superior and inferior.
• Medially, the symphysial surface of the body
articulates with the corresponding surface of
the contralateral pubis, pubic symphysis.
• The anterosuperior border of the united bodies
and symphysis forms the pubic crest.
• Small projections at the lateral ends of this
crest, the pubic tubercles, are important
landmarks of the inguinal regions. The tubercles
provide attachment for the medial part of the
inguinal ligament.
• The posterior margin of the superior ramus of
the pubis has a sharp raised edge, the pecten
pubis.
Obturator Foramen
• The obturator foramen is a
large oval aperture in the
hip bone.
• It is bounded by the pubis
and ischium and their rami.
Except for a small
passageway for the
obturator nerve & vessels
(the obturator canal),
• the obturator foramen is
closed by the thin, strong
obturator membrane.
Acetabulum
• The acetabulum is the large cup-
shaped cavity or socket on the
lateral aspect of the hip bone that
articulates with the head of the
femur to form the hip joint .
• The margin of the acetabulum is
incomplete inferiorly at the
acetabular notch. The rough
depression in the floor of the
acetabulum extending superiorly
from the acetabular notch is the
acetabular fossa.
Injuries of the Hip Bone (Pelvic Injuries)
• Fractures of the hip bone are commonly
referred to as pelvic fractures.

• Avulsion fractures of the hip bone may

occur during sports that require sudden
acceleration or deceleration forces,
such as sprinting or kicking in football,
soccer, hurdle jumping, basketball, and
martial arts.
 The Femur (ant. view)
Greater
& Lesser Head
Trochanter Neck
s
Intertrochanteric Line
Body (shaft)

Adductor tubercle
Lateral epicondyle
Medial epicondyle
Lateral condyle
Medial condyle
 The Femur (post. view)
1. Intertrochanteric
Crest
4. Pectineal Line 2. Quadrate Tubercle

3. Gluteal Tuberosity

5. Linea Aspera
7. Popliteal Surface
The trochanters,
Medial and Lateral .6 tubercles, lines and
Supracondylar Lines epicondyles are sites of
muscle and ligament
attachment
8. Intercondylar notch
 Angle of Inclination
(Between the femoral neck and shaft)

Approx. 125o
•The angle of
inclination is
measured in the
frontal plane and
typically ranges from
115 to 140 degrees.
 • An angle between
Coxa Vara femoral neck and shaft
less than 115°; increases
stress on femoral neck.
• This:
1. shortens the limb;
2. decreases the
effectiveness of the
abductors;
3. increases the load on the
femoral neck;
4. reduces the load on the
femoral head.
 • An angle between femoral
Coxa Valga neck and shaft greater than
140°; increases pressure
into the joint
• This:
1. lengthens the limb;
2. mimics contracture of the hip
abductors;
3. reduces the load on the
femoral neck;
4. increases the load on the
femoral head.

A contracture is a permanent tightening of muscles, tendons,

ligaments, or skin that prevents movement of the associated body
part.
 Angle of Torsion
The angle between the axis of the neck and the
transverse axis that passes through the femoral
condyles

a b c

Normal 12o -14o Retroversion <12o Anteversion >15o

Excessive Anteversion

•An increase in the

angle of torsion
(anteversion)
influences the rotation
of the limb and
produces a toe in gait
(pigeon toes).
Retroversion

•A decrease in the
angle of torsion
(retroversion)
influences the
rotation of the limb
and produces a toe
out gait (duck feet).
Femur
• The femur is the
longest and heaviest
bone in the body.
• It transmits body
weight from the hip
bone to the tibia when
a person is standing.
• The femur consists of
a shaft (body) and two
ends, superior or
proximal and inferior
or distal .
Femur
• The superior (proximal)
end of the femur consists
of a head, neck, and two
trochanters (greater and
lesser).

• The round head of the

femur is covered with
articular cartilage, except
for a medially placed
depression or pit, the
fovea for the ligament of
the head.
Femur
• The neck of the
femur is
trapezoidal,
with its narrow
end supporting
the head and its
broader base
being
continuous with
the shaft.
• The proximal femur is bent (L-shaped)
so that the long axis of the head and
neck projects superomedially at an
angle to that of the obliquely oriented
shaft.

• The angle is less in females because of

the increased width between the
acetabula (a consequence of a wider
lesser pelvis) and the greater obliquity
of the shaft.
• The angle of inclination allows greater
mobility of the femur at the hip joint
because it places the head and neck more
perpendicular to the acetabulum in the
neutral position.

• The angle also allows the obliquity of the

femur within the thigh, which permits the
knees to be adjacent and inferior to the
trunk,
• All of this is advantageous for bipedal
walking; however, it imposes
considerable strain on the neck of the
femur.

• Consequently, fractures of the

femoral neck can occur in older people
as a result of a slight stumble if the
neck has been weakened by
osteoporosis
• The torsion of the proximal lower limb (femur) that occurred
during development.
• When the femur is viewed superiorly, it is apparent that the
two axes lie at an angle (the torsion angle, or angle of
declination), the mean of which is 7° in males and 12° in
females.
• The torsion angle, combined with the angle of inclination,
allows rotatory movements of the femoral head.
• Where the neck joins the
femoral shaft are two large,
blunt elevations called
trochanters.
• The abrupt, conical and
rounded lesser trochanter
extends medially from the
posteromedial part of the
junction of the neck and
shaft to give tendinous
attachment to the primary
flexor of the thigh (the
iliopsoas).
• The greater trochanter is
a large, laterally placed
bony mass that projects
superiorly and
posteriorly where the
neck joins the femoral
shaft, providing
attachment and leverage
for abductors and
rotators of the thigh.
• The site where the neck
and shaft join is indicated
by the intertrochanteric
line, a roughened ridge
formed by the attachment
of a powerful ligament
(iliofemoral ligament).
• A similar but
smoother &
more prominent
ridge, the
intertrochanteri
c crest, joins the
trochanters
posteriorly. The
rounded
elevation on the
crest is the
quadrate
tubercle
• The shaft of the femur is convex
anteriorly.
• This convexity may increase markedly,
proceeding laterally as well as
anteriorly, if the shaft is weakened by a
loss of calcium, as occurs in rickets.
The shaft is providing fleshy origin to extensors of the
knee, except posteriorly where a broad, rough line, the
linea aspera, provides attachment for adductors of the
thigh.
This vertical ridge is especially prominent in the middle
third of the femoral shaft, where it has medial and lateral
lips (margins).
Superiorly, the lateral lip blends with the broad, rough
gluteal tuberosity, and the medial lip continues as a
narrow, rough spiral line.
The spiral line extends toward the lesser trochanter but
then passes to the anterior surface of the femur, where it
is continuous with the intertrochanteric line.
• A prominent
intermediate ridge, the
pectineal line, extends
from the central part of
the linea aspera to the
base of the lesser
trochanter.
• Inferiorly, the linea
aspera divides into
medial and lateral
supracondylar lines,
which lead to the
spirally curved medial
and lateral condyles.
The medial and lateral femoral condyles make up nearly
the entire inferior end of the femur.
The femoral condyles articulate with tibial condyles to form
the knee joint.
The condyles are separated posteriorly and inferiorly by an
intercondylar fossa (intercondylar notch) but merge
anteriorly, forming a shallow longitudinal depression, the
patellar surface, which articulates with the patella.
The lateral surface of the lateral condyle has a central
projection called the lateral epicondyle.
The medial surface of the medial condyle has a larger and
more prominent medial epicondyle, superior to which
another elevation, the adductor tubercle.
The epicondyles provide proximal attachment for the
collateral ligaments of the knee joint.
Coxa Vara and Coxa Valga
• The angle of inclination between the
long axis of the femoral neck & the
femoral shaft varies with age, sex, and
development of the femur (e.g., a
congenital defect in the ossification of
the femoral neck).
• It may also change with any
pathological process that weakens the
neck of the femur (e.g., rickets).
• When the angle of inclination is
decreased, the condition is coxa vara;
when it is increased, it is coxa valga.
• Coxa vara causes a mild shortening of
the lower limb and limits passive
abduction of the hip.
Tibia and Fibula
The tibia and fibula are the bones of
the leg. The tibia articulates with
the condyles of the femur
superiorly and the talus inferiorly
and in so doing transmits the body's
weight.
The fibula mainly functions as an
attachment for muscles and also
important for the stability of the
ankle joint.
The shafts (bodies) of the tibia and
fibula are connected by a dense
interosseous membrane composed
of strong oblique fibers.
Tibia
Located on the anteromedial side of the leg, nearly parallel to the fibula,
the tibia (shin bone) is the second largest bone in the body.
The superior (proximal) end widens to form medial and lateral condyles
that overhang the shaft medially, laterally, and posteriorly, forming a
relatively flat superior articular surface.
The articular surfaces are separated by an intercondylar eminence
formed by two intercondylar tubercles (medial and lateral) flanked by
relatively rough anterior and posterior intercondylar areas.

The intercondylar
tubercles and areas
provide attachment for
the menisci and principal
ligaments of the knee,
which hold the femur
and tibia together,
maintaining contact
between their articular
surfaces.
The anterolateral aspect of the
lateral tibial condyle bears an
anterolateral tibial tubercle
(Gerdy tubercle) inferior to the
articular surface, which
provides the distal attachment
for a dense thickening of the
fascia covering the lateral thigh,
adding stability to the knee
joint.
The lateral condyle also bears a
fibular articular facet
posterolaterally on its inferior
aspect for the head of the
fibula.
The shaft of the tibia is vertical and
somewhat triangular in cross section,
having three surfaces and borders:
medial, lateral/interosseous, and
posterior.

The anterior border of the tibia is the

most prominent border; it and the
adjacent anterior surface are
subcutaneous throughout their lengths
and are commonly known as the shin or
shin bone.

The distal end of the tibia is smaller than

the proximal end, flaring only medially;
the medial expansion extends inferior to
the rest of the shaft as the medial
malleolus.
The inferior surface of the
shaft and the lateral surface
of the medial malleolus
articulate with the talus
and are covered with
articular cartilage.
The interosseous border of
the tibia is sharp where it
gives attachment to the
interosseous membrane that
unites the two leg bones.
Inferiorly, the sharp border
is replaced by a groove,
the fibular notch, that
accommodates and provides
fibrous attachment to the
distal end of the fibula.
On the posterior surface
of the proximal part of the
tibial shaft is a rough
diagonal ridge, called the
soleal line, which runs
inferomedially to the
medial border; origin of
the soleus muscle
approximately one third
of the way down the
shaft.
Fibula
The slender fibula lies
posterolateral to the tibia and is
firmly attached to it by the
tibiofibular syndesmosis, which
includes the interosseous
membrane.
The fibula has no function in
weight bearing; it serves mainly
for muscle attachment, providing
distal attachment (insertion) for
one muscle and proximal
attachment (origin) for eight
muscles.
The distal end enlarges and is prolonged laterally and inferiorly as
the lateral malleolus.
The malleoli form the outer walls of a rectangular socket
(mortise), which is the superior component of the ankle joint,
and provide attachment for the ligaments that stabilize the joint.
The lateral malleolus is more prominent and posterior than the
medial malleolus and extends approximately 1 cm more distally.
The proximal end of the fibula
consists of an enlarged head and
smaller neck; the head has a
pointed apex.
The head articulates with the
fibular facet on the posterolateral,
inferior aspect of the lateral tibial
condyle.
The shaft of the fibula is twisted
and marked by the sites of
muscular attachments. Like the
shaft of the tibia, it is triangular in
cross section, having three borders
(anterior, interosseous, and
posterior) and three surfaces
(medial, posterior, and lateral).
Fibular Fractures
Fibular fractures commonly occur 2 - 6 cm proximal to
the distal end of the lateral malleolus and are often
associated with fracture dislocations of the ankle joint,
which are combined with tibial fractures.
When a person slips and the foot is forced into an
excessively inverted position, the ankle ligaments tear,
forcibly tilting the talus against the lateral malleolus and
shearing it off .
Fractures of the lateral and medial malleoli are relatively
common in soccer and basketball players. Fibular
fractures can be painful owing to disrupted muscle
attachments; walking is compromised because of the
bone's role in ankle stability.
Bone Grafts
If a part of a major bone is destroyed by injury or disease, the limb becomes
useless. Replacement of the affected segment by a bone transplant may avoid
amputation.
The fibula is a common source of bone for grafting. Even after a segment of shaft
has been removed, walking, running, and jumping can be normal.
Free vascularized fibulas have been used to restore skeletal integrity to upper and
lower limbs in which congenital bone defects exist and to replace segments of
bone after trauma or excision of a malignant tumor.
The remaining parts of the fibula usually do not regenerate because the
periosteum and nutrient artery are generally removed with the piece of bone so
that the graft will remain alive and grow when transplanted to another site.
Secured in its new site, the fibular segment restores the blood supply of the bone
to which it is now attached. Healing proceeds as if a fracture had occurred at each
of its ends.
Awareness of the location of the nutrient foramen in the fibula is important
when performing free vascularized fibular transfers. Because the nutrient
foramen is located in the middle third of the fibula in most cases, this segment of
the bone is used for transplanting when the graft must include a blood supply to
the marrow cavity as well as to the compact bone of the surface (via the
periosteum).
Bones of the Foot
The bones of the foot include the tarsus,
metatarsus, and phalanges. There are 7
tarsal bones, 5 metatarsal bones, and 14
phalanges.
Tarsus
The tarsus (posterior or proximal foot; hindfoot) consists of seven bones:
talus, calcaneus, cuboid, navicular, and three cuneiforms. Only one bone,
the talus, articulates with the leg bones.
The talus has a body, neck, and head. The superior surface, or trochlea of
the talus, is gripped by the two malleoli and receives the weight of the
body from the tibia. It transmits that weight in turn, dividing it between the
calcaneus, on which the talar body rests, and the forefoot, via an
osseoligamentous hammock' that receives the rounded and anteromedially
directed talar head.
The hammock (spring ligament) is suspended across a gap between the
talar shelf (a bracket-like lateral projection of the calcaneus) and the
navicular bone, which lies anteriorly .
The talar body bears the trochlea superiorly and narrows into a posterior
process that features a groove for the tendon of the flexor hallucis longus,
flanked by a prominent lateral tubercle and a less prominent medial
tubercle.
The calcaneus (heel bone) is the largest and strongest
bone in the foot.
When standing, the calcaneus transmits the majority of
the body's weight from the talus to the ground.
The anterior two thirds of the calcaneus's superior surface
articulates with the talus and its anterior surface
articulates with the cuboid.
The lateral surface of the calcaneus has an oblique ridge,
the fibular trochlea.
On the medial side, the talar shelf (L. sustentaculum tali),
the shelf-like support of the talus, projects from the
superior border of the medial surface of the calcaneus
and participates in supporting the talar head.
The posterior part of the calcaneus has a massive, weight-
bearing prominence, the calcaneal tuberosity.
The navicular (L. little ship) is a flattened, boat-
shaped bone located between the talar head
posteriorly and the three cuneiforms anteriorly.
The medial surface of the navicular projects
inferiorly to form the navicular tuberosity.
It forms a longitudinal arch of the foot, which
must be supported centrally.
If this tuberosity is too prominent, it may press
against the medial part of the shoe and cause
foot pain.
The cuboid, approximately cubical in
shape, is the most lateral bone in the
distal row of the tarsus.
Anterior to the tuberosity of the
cuboid on the lateral and inferior
surfaces of the bone is a groove for
the tendon of the fibularis longus
muscle.
The three cuneiforms are the medial (1st),
intermediate (2nd), and lateral (3rd).
The medial cuneiform is the largest bone,
and the intermediate cuneiform is the
smallest.
Each cuneiform (L. cuneus, wedge shaped)
articulates with the navicular posteriorly
and the base of its appropriate metatarsal
anteriorly.
The lateral cuneiform also articulates with
the cuboid.
Metatarsus
The metatarsus (anterior or distal foot, forefoot) consists
of five metatarsals that are numbered from the medial
side of the foot. In the articulated skeleton of the foot ,
the tarsometatarsal joints form an oblique tarsometatarsal
line joining the midpoints of the medial and shorter lateral
borders of the foot; thus the metatarsals and phalanges
are located in the anterior half (forefoot) and the tarsals
are in the posterior half (hindfoot)
The 1st metatarsal is shorter and stouter than the others.
The 2nd metatarsal is the longest.
Each metatarsal has a base proximally, a shaft, and a head
distally. The base of each metatarsal is the larger,
proximal end.
The bases of the metatarsals articulate with the
cuneiform and cuboid bones, and the heads articulate
with the proximal phalanges.
On the plantar surface of the head of the 1st metatarsal
are prominent medial and lateral sesamoid bones (not
shown); they are embedded in the tendons passing along
the plantar surface.
Phalanges
The 14 phalanges are as follows: the 1st digit (great
toe) has 2 phalanges (proximal and distal); the other
four digits have 3 phalanges each: proximal, middle,
and distal. Each phalanx has a base (proximally), a shaft,
and a head (distally). The phalanges of the 1st digit are
short, broad, and strong. The middle and distal
phalanges of the 5th digit may be fused in elderly
people.
Os Trigonum
During ossification of the talus, the secondary ossification center,
which becomes the lateral tubercle of the talus, occasionally fails
to unite with the body of the talus. This failure may be caused by
applied stress (forceful plantarflexion) during the early teens.
Occasionally, a partly or even fully ossified center may fracture
and progress to non-union.
Either event may result in a bone (accessory ossicle) known as an
os trigonum, which occurs in 14 - 25% of adults, more commonly
bilaterally.
It has an increased prevalence among soccer players and ballet
dancers. Patients with an os trigonum may be symptomatic or
pain free. Radionuclide bone scanning, which provides
physiological as well as anatomical evidence, is useful in
distinguishing symptomatic and asymptomatic ossicles. (Lawson,
1994)