Bones of the Hip Ilium Iliac fossa Iliac

Bones of the Hip

Ilium • Iliac fossa • Iliac ala • Arcuate line – True pelvis – False pelvis • Acetabulum

Male and female pelvis

Differences • Angle of pubic arch – female wider • Pelvic inlet – female larger • Sacrum – female less curved • Obturator foramen – female oval, male round • Iliac ala – female wider and shallower

figure

Iliac crest • Thicker posteriorly • Highest point palpated posteriorly is at level of L 4 • Lips of iliac crest – Internal lip – Intermediate lip – External lip

L 4 is colored

Attachments to lips • Internal lip – Anterior lip - Transversus abdominis muscle – Middle lip - Quadratus lumborum muscle – Posterior lip - Sacrospinalis muscle (erector spinae muscles of back) • Intermediate lip – Anterior lip – internal abdominal oblique muscle

• External lip – Anterior lip – external abdominal oblique muscle – Anterior lip – origin of tensor fascia latae muscle – Posterior lip – origin of latissimus dorsi muscle – Whole lip – fascia lata (deep fascia of the thigh)

Other Structures on Iliac Crest • Anterior Superior Iliac Spine (ASIS) – Sartorius muscle – Tensor fascia latae • Posterior Superior Iliac Spine (PSIS) – Skin dimples on back – Level of S 2 vertebrae

Other Structures on the Ilium • Anterior Inferior Iliac Spine – Origin of part of rectus femoris muscle – Attachment for iliofemoral ligament • Posterior Inferior Iliac Spine – Posterior part of the surface that articulates with the sacrum

• Greater Sciatic Notch – Posterior part of ilium – Just inferior to the PIIS – Next slide – structures that pass through the greater sciatic notch

• • • Superior gluteal nerve and vessels Piriformis muscle Inferior gluteal nerve and vessels Sciatic nerve Nerve to superior gemellus and obturator internus muscles • Nerve to inferior gemellus and quadratus femoris muscles • Pudendal nerve and vessels • Posterior femoral cutaneous nerve • Note structures which are above and below the piriformis muscle

Post hip fig

Post hip 2

Structures on the external surface of the ilium • Three gluteal lines – Posterior Gluteal line – Anterior Gluteal line – Inferior Gluteal line – Rough area above acetabulum • Origin of reflected head of the rectus femoris muscle

Gluteal lines on ADAM • Origins of: – Gluteus maximus – Gluteus medius – Gluteus minimus

The ISCHIUM • Body of the ischium – External surface is the articular and nonarticular surface of the acetabulum • Acetabulum – Articular surface – lunate surface which articulates with the head of the femur – Non-articular surface – acetabular fossa

• Internal surface of ischium – Forms part of the wall of the true pelvis

Structures on posterior border of ischium • Ischial spine – Separates the greater and the lesser sciatic notches – Origin of superior gemellus muscle – Attachment site for the sacrospinous ligament • Ligament helps convert the greater sciatic notch into the greater sciatic foramen • Part of sacroischial joint

Post hip lig

• Lesser Sciatic notch – Passageway for: • Obturator internus muscle • Nerve to obturator internus muscle • Pudendal nerve and vessles – Note these also travel through the greater sciatic notch

• Ischial tuberosity – Attachment of hamstring muscles • Long head of the biceps femoris muscle • Semitendinosus muscle • Semimembranosus muscle – Origin of Inferior Gemellus muscle – Attachment of sacrotuberous ligament • Part of sacroischial joint • Helps convert both the greater and lesser sciatic notches into foramen

• Superior ischial ramus – External or lateral wall • Origin of quadratus femoris muscle – On ridge between the superior ischial ramus and the ischial tuberosity – Lower part is part of the origin of the obturator externus muscle

The PUBIS • Body of the pubis – External surface - acetabulum • Articular surface • Non-articular surface – acetabular fossa – Internal surface • Forms part of wall of true pelvis

Superior Ramus of the Pubis • External surface – Origin of adductor longus muscle • Just below pubic crest • Internal surface – part of wall of true pelvis

• Superior border of superior ramus (medial part) – Pubic crest – RA and pyramidalis – Pubic tubercle – inguinal ligament – Medial border – articular surface for attachment of fibrocartilage of pubic symphysis – Lateral part – part of edge of obturator foramen

• Superior border of superior ramus (lateral part) – Pectineal line – origin of pectineus muscle – Iliopubic eminence • Junction of iliac and pubic bones • Insertion of psoas minor muscle

• Inferior surface of superior pubic ramus – Obturator crest – part of margin of obturator foramen – Obturator “groove” – passageway for obturator nerve and vessels as they pass through the obturator foramen – Posterior surface – part of origin of obturator internus muscle

Inferior pubic ramus • External surface – Origin of adductor brevis muscle – Origin of gracilis muscle – Origin of adductor magnus muscle (lateral) – Origin of obturator externus muscle (bone near foramen)

Structures common to more than one part of the innominate bone • Acetabulum • Obturator foramen

Acetabulum • Lateral innominate bone • Surfaces – Lunate surface – articulating with head of femur – Non-articulating surface – acetabular fossa • Contains a fat pad • Acetabular notch – gap in wall of acetabulum – Attachment of ligamentum teres (ligament of the head of the femur) – Transverse ligament attaches to the edges of the notch and completes the articular surface

Obturator foramen • Covered by obturator membrane • Origin of obturator internus – from inner (posterior) surface of the membrane and the surrounding bone • Origin of obturator externus – from the external (anterior) surface of the membrane and the surrounding bone • Passageway through the membrane for obturator nerve and vessels to the medial thigh

Passages • Structures that enter the lower extremity must travel through the pelvis • There are several different ways that structures (nerves, blood vessels, lymph vessels, muscles and tendons) can travel through or around the pelvis

• Greater Sciatic Notch – Many structures – Sciatic nerve – Superior and inferior gluteal nerves and vessels – Piriformis muscle • Lesser Sciatic Notch – Pudendal nerve and vessels travels back through – Obturator internus muscle and its nerve

Obturator foramen • Obturator nerve and vessels through an opening in the obturator membrane at the obturator groove

Structures which pass over the pelvic brim to lower extremity • • • Tendon of the iliacus muscle Tendon of the psoas major muscle Femoral Nerve, Artery and Vein Lateral femoral cutaneous nerve Lymph vessels

Femoral triangle fig

Post hip lig

Post hip 2

Quiz on bony landmarks • http: //www. mhhe. com/biosci/ap/saladin 2 e/ graphics/saladin 02 ap/ch 09/others/chap 09 l abeling 09. html • http: //www. mhhe. com/biosci/ap/saladin 2 e/ graphics/saladin 02 ap/ch 09/others/chap 09 l abeling 08. html