osteology lower limb,by dr iram

Osteology of Femur & TibiaOsteology of Femur & TibiaDr Iram IqbalDr Iram Iqbal

SequenceSequence G features and attachments of FemurG features and attachments of Femur Ossification and blood supply of femurOssification and blood supply of femur Applied anatomyApplied anatomy G features and attachments of TibiaG features and attachments of Tibia Ossification and blood supply of Ossification and blood supply of Applied anatomyApplied anatomy DevelopmentDevelopment ConclusionConclusion ReferencesReferences

FEMURFEMUR

Longest and Longest and strongest bone strongest bone in human bodyin human body

Two ends Two ends (proximal and (proximal and distal) and shaftdistal) and shaft

Shaft runs Shaft runs obliquely from obliquely from proximal to proximal to distal enddistal end

Right Femur (Anterior View)

FEMORAL HEADFEMORAL HEAD

1.1. Directed medially, Directed medially, upwards and upwards and slightly forwardsslightly forwards

• Articulates with the Articulates with the acetabulum to form acetabulum to form hip jointhip joint

• A roughened pit is A roughened pit is situated just below situated just below and behind the and behind the centre of the head centre of the head called foveacalled fovea

Left Femur (Posterior View)

1.1.FEMORAL NECKFEMORAL NECK

• It is about 5 cm longIt is about 5 cm long• It connects the head to It connects the head to

the shaft at an angle the shaft at an angle of(120 -135°) (angle of of(120 -135°) (angle of inclination or neck-shaft inclination or neck-shaft angle)angle)

• Neck–shaft angle Neck–shaft angle facilitates movements at facilitates movements at the hip jointthe hip joint

• Femoral neck has two Femoral neck has two borders and two surfacesborders and two surfaces

• Upper & Lower borderUpper & Lower border• Anterior & Posterior Anterior & Posterior

surfacesurface


°(Angle Of Inclination Or Neck-shaft Angle)°(Angle Of Inclination Or Neck-shaft Angle)

( Torsion Angle Of Femur)( Torsion Angle Of Femur)

2.2. FEMORAL NECKFEMORAL NECKThe upper border is The upper border is

concave and meets concave and meets the shaft at the the shaft at the greater trochantergreater trochanter

The lower border is The lower border is straight and meets the straight and meets the shaft near the shaft near the lesser lesser trochantertrochanter

The anterior surface is The anterior surface is flat and meets the flat and meets the shaft at the shaft at the inter-inter-trochanteric linetrochanteric line

The posterior surface The posterior surface is convex and meets is convex and meets the shaft at the the shaft at the inter-inter-trochanteric cresttrochanteric crest Left Femur (Posterior View)

3..GREATER TROCHANTER


. The greater trochanter is large and quadrangular, projecting up from the junction of the neck and shaft•Rough, depressed area on the medial surface is the trochanteric fossa•The anterior surface bears a rough impression• Its lateral surface is divided into two areas by an oblique flat strip, which crosses it down and forwards

4.4. LESSER TROCHANTERLESSER TROCHANTER

A conical A conical posteromedial posteromedial projection of the projection of the shaftshaft

Its anterior Its anterior surface is rough, surface is rough, and posterior and posterior surface at the surface at the distal end of the distal end of the inter-trochanteric inter-trochanteric crest is smoothcrest is smooth Left Femur (Posterior View)

5.5.INTER-TROCHANTERIC LINEINTER-TROCHANTERIC LINE

• A prominent A prominent ridge at the ridge at the junction of the junction of the anterior surface anterior surface of the neck and of the neck and shaftshaft

• It descends It descends medially and medially and continuous below continuous below with the spiral with the spiral line in front of the line in front of the lesser trochanterlesser trochanter

Left Femur (Anterior View)

66.INTER-TROCHANTERIC CREST.INTER-TROCHANTERIC CREST

.. Smooth ridge at Smooth ridge at the junction of the junction of posterior surface of posterior surface of neck with the shaftneck with the shaft

A little above its A little above its centre there is a centre there is a low, rounded low, rounded quadrate tuberclequadrate tubercle


B. B. SHAFTSHAFTConvex forwardsConvex forwards, ,

narrowest centrally narrowest centrally Directed obliquely Directed obliquely

downwards and downwards and mediallymedially

In the upper 1/3 of In the upper 1/3 of the shaft,the two lips the shaft,the two lips of the of the linea asperalinea aspera divergediverge

FourFour surfaces in surfaces in upper third, upper third, ThreeThree in in middle third, and middle third, and fourfour in lower thirdin lower third

Right Femur (Posterior View)

C.C. DISTAL ENDDISTAL END

It consists of two massive condyles (a medial and a It consists of two massive condyles (a medial and a lateral condyle), inter-condylar fossa and a large articular lateral condyle), inter-condylar fossa and a large articular surface surface

Anteriorly the condyles unite and continue into the shaftAnteriorly the condyles unite and continue into the shaft Posteriorly they are separated by a deep inter-Condylar Posteriorly they are separated by a deep inter-Condylar

fossafossa

Right Femur (Inferior View)

DISTAL ENDDISTAL END

……

The The articular surfacearticular surface forms a broad area, like forms a broad area, like an inverted U and is an inverted U and is divisible into patellar and divisible into patellar and tibial surfacetibial surface

The The patellar surfacepatellar surface extends over the anterior extends over the anterior surface of both condyles surface of both condyles but more on the lateral but more on the lateral condyle condyle

It is It is concave concave from side to from side to sideside

The The tibial surfacetibial surface covers the inferior and covers the inferior and posterior surfaces of posterior surfaces of both the condylesboth the condyles

It is separated It is separated posteriorly by posteriorly by intercondylar fossaintercondylar fossa and and merges anteriorly with merges anteriorly with the patellar surfacethe patellar surface

Distal End Left Femur

Medial condyleMedial condyle has a has a bulging on convex medial bulging on convex medial aspect that can be aspect that can be palpatedpalpated

Its uppermost part has a Its uppermost part has a small projection called small projection called adductor tubercleadductor tubercle

Below and little in front of Below and little in front of adductor tubercle is adductor tubercle is medial medial epicondyleepicondyle

Lateral condyleLateral condyle is not so is not so prominent as the medial prominent as the medial condyle but is stouter and condyle but is stouter and strongerstronger

The most prominent point The most prominent point on its lateral aspect is is on its lateral aspect is is the the lateral epicondylelateral epicondyle

Intercondylar fossaIntercondylar fossa Right Femur (Posterior View)

Right Femur (Inferior View)

Muscular Muscular attachmentsattachments

OSSIFICATION OF OSSIFICATION OF FEMURFEMUR

Femur ossifies from Femur ossifies from fivefive centers centers (one primary(one primary in the shaft, and in the shaft, and fourfour secondary- secondary- each in head, greater each in head, greater

trochanter, lesser trochanter trochanter, lesser trochanter

and distal end)and distal end) Other than the clavicle, it is the firstOther than the clavicle, it is the first

long bone to ossify long bone to ossify The primary center for the shaftThe primary center for the shaft

appears in the appears in the 77thth week of intra week of intra-uterine life -uterine life

The secondary center for the The secondary center for the lowerlower

end at the end of the 9end at the end of the 9thth month month of of

intra-uterine lifeintra-uterine life

The secondary center The secondary center for the head appears for the head appears during the during the first 6 first 6 months of life months of life

Secondary center for Secondary center for the greater trochanter the greater trochanter appears during the appears during the 44thth yearyear

And for the lesser And for the lesser trochanter during the trochanter during the 1212thth year year

Blood supplyBlood supply Vascular supplyVascular supply blood supply of the femoral head is blood supply of the femoral head is

derived from an arterial ring around the neck, just derived from an arterial ring around the neck, just outside the attachment of the fibrous capsule, outside the attachment of the fibrous capsule, constituted by the medial and lateral circumflex arteries constituted by the medial and lateral circumflex arteries with minor contributions from the superior and inferior with minor contributions from the superior and inferior gluteal vessels. From this ring, ascending cervical gluteal vessels. From this ring, ascending cervical branches pierce the capsule to ascend the neck beneath branches pierce the capsule to ascend the neck beneath the reflected synovial membrane. These vessels become the reflected synovial membrane. These vessels become the retinacular arteries and form a sub synovial intra-the retinacular arteries and form a sub synovial intra-articular ring. Here the vessels are at risk with a articular ring. Here the vessels are at risk with a displaced fracture of the femoral neck. Interruption of displaced fracture of the femoral neck. Interruption of blood supply in this way can lead to avascular necrosis blood supply in this way can lead to avascular necrosis of the femoral head. If the fracture is intra-articular then of the femoral head. If the fracture is intra-articular then not only is the interosseous blood supply damaged but not only is the interosseous blood supply damaged but the retinacular vessels can also be vulnerable. If the the retinacular vessels can also be vulnerable. If the fracture is extra capsular, the retinacular vessels will fracture is extra capsular, the retinacular vessels will remain intact and avascular necrosis of the femoral head remain intact and avascular necrosis of the femoral head does not occur.does not occur.

Blood supply of head of Blood supply of head of femurfemur

Clinical AnatomyClinical Anatomy The distal end of the femur is the only epiphysis The distal end of the femur is the only epiphysis

in which ossification constantly starts in which ossification constantly starts just before just before birthbirth, a most reliable indicator that a dead , a most reliable indicator that a dead newborn child was viablenewborn child was viable

Since the growth in length takes place chiefly Since the growth in length takes place chiefly from the from the lower epiphysiallower epiphysial cartilage so surgeon cartilage so surgeon needs to be carefulneeds to be careful

Lower epiphyseal line passes through the Lower epiphyseal line passes through the adductor tubercleadductor tubercle

Neck represents the upper end of shaft b/c it Neck represents the upper end of shaft b/c it ossifies from the primary centre.ossifies from the primary centre.

injuriesinjuries Below the age of 16 Below the age of 16 there is spiral fracture of the there is spiral fracture of the

shaftshaft Bucket handle tear of the medial meniscusBucket handle tear of the medial meniscus b/e b/e

the the age of 14-40 yrsage of 14-40 yrs Over 60Over 60 fracture of the femoral neck is common fracture of the femoral neck is common

because of osteoporotic changes in ageing bones. because of osteoporotic changes in ageing bones. Women are more liable, their bones being lightly Women are more liable, their bones being lightly builtbuilt

Pott,s fracture of the leg b/e the age of 40-60Pott,s fracture of the leg b/e the age of 40-60 Avascular necrosis of head of femurAvascular necrosis of head of femur in intra- in intra-

articular displaced fracture of femoral neckarticular displaced fracture of femoral neck

BUCKET HANDLE BUCKET HANDLE TEARTEAR

Spiral fracture of Spiral fracture of the shaftthe shaft

"Bucket-handle Tear"Bucket-handle Tear””

. These large tears tend to occur in younger . These large tears tend to occur in younger patients, and are always traumatic injuries.patients, and are always traumatic injuries.

bucket-handle tear is a bucket-handle tear is a tear around the rim of the meniscustear around the rim of the meniscus, , causing the central portion (the bucket-causing the central portion (the bucket-handle) to displace into the joint. These handle) to displace into the joint. These types of tears generally involve large types of tears generally involve large amounts of the meniscus, and are often amounts of the meniscus, and are often amenable toamenable tomeniscus repairmeniscus repair (rather (rather than than removal of the meniscusremoval of the meniscus). ).

Patients with these bucket-handle tears Patients with these bucket-handle tears may have limited motion of the knee joint may have limited motion of the knee joint if the meniscus tear is large enough to get if the meniscus tear is large enough to get caught inside the knee.caught inside the knee.

Pott fracture, dislocation of ankle Pott fracture, dislocation of ankle jointjoint

A A Pott fracture-Pott fracture-dislocation of the ankledislocation of the ankle occurs when the foot is occurs when the foot is forcibly averted. (combined forcibly averted. (combined abduction external rotation abduction external rotation from an eversion force)from an eversion force)

This action pulls on the This action pulls on the extremely strong medial extremely strong medial ligament, often tearing off ligament, often tearing off the medial malleolus.the medial malleolus.

The talus then moves The talus then moves laterally, shearing off the laterally, shearing off the lateral malleolus or, more lateral malleolus or, more commonly, breaking the commonly, breaking the fibula superior to the fibula superior to the tibiofibular syndesmosis.tibiofibular syndesmosis.

If the tibia is carried If the tibia is carried anteriorly, the posterior anteriorly, the posterior margin of the distal end of margin of the distal end of the tibia is also sheared off the tibia is also sheared off by the talus. by the talus.

""trimalleolar fracturetrimalleolar fracture""

The combined fracture of the medial The combined fracture of the medial malleolus, lateral malleolus, and the malleolus, lateral malleolus, and the posterior margin of the distal end of the posterior margin of the distal end of the tibia is known as a "trimalleolar tibia is known as a "trimalleolar fracture.“In a "fracture.“In a "trimalleolar fracturetrimalleolar fracture" the " the posterior distal end of the tibia is posterior distal end of the tibia is erroneously labeled as a malleoluserroneously labeled as a malleolus. .

Avascular necrosis of head of Avascular necrosis of head of femurfemur

Coxa Vara and Coxa ValgaCoxa Vara and Coxa Valga

The angle of inclination varies with age, The angle of inclination varies with age, sex, and development of the femur (e.g., sex, and development of the femur (e.g., consequent to a congenital defect in consequent to a congenital defect in ossification of the femoral neck). It also ossification of the femoral neck). It also may change with any pathological process may change with any pathological process that weakens the neck of the femur (e.g., that weakens the neck of the femur (e.g., rickets). When the angle of inclination is rickets). When the angle of inclination is decreased, the condition is decreased, the condition is Coxa varaCoxa vara, , when it is increased, the condition is . when it is increased, the condition is . Coxa valgaCoxa valga causes a mild passive causes a mild passive abduction of the hip.abduction of the hip.

Coxa Vara and Coxa ValgaCoxa Vara and Coxa Valga

Fracture of femurFracture of femur Fracture of upper end (neck)Fracture of upper end (neck)

– IntracapsularIntracapsular Sub capitalSub capital Trans cervicalTrans cervical basalbasal

– Extra capsularExtra capsular IntrtrochantericIntrtrochanteric

Fracture of shaftFracture of shaft– Type I - Spiral or transverse (most common)Type I - Spiral or transverse (most common)– Type II - ComminutedType II - Comminuted– Type III - OpenType III - Open

Associated injuries are common.Associated injuries are common.

Classification based on appearance Classification based on appearance of hip on AP view of Xrayof hip on AP view of Xray

– stageI stageI : incomplete fracture of the neck : incomplete fracture of the neck (so-called abducted or impacted)(so-called abducted or impacted)

– stage IIstage II : complete without : complete without displacementdisplacement

– stage IIIstage III: complete with partial : complete with partial displacement: displacement:

– stage IVstage IV : this is a complete femoral : this is a complete femoral neck fracture with full displacement: neck fracture with full displacement:

OVERVIEW OF LIGAMENTSOVERVIEW OF LIGAMENTS

The knee is stabilized by four main ligaments: The knee is stabilized by four main ligaments: 2 2 collateral ligamentscollateral ligaments ( (medial medial andand lateral lateral) and ) and 2 2 cruciate ligamentscruciate ligaments both both anterioranterior (front) and (front) and posterior posterior (back). (back).

The cruciate ligaments attach to the femur (thigh The cruciate ligaments attach to the femur (thigh bone) and travel within the knee joint to the upper bone) and travel within the knee joint to the upper surface of the tibia (shin bone). The ligaments pass surface of the tibia (shin bone). The ligaments pass each other in the middle of the joint forming a each other in the middle of the joint forming a cross shape, hence the name cross shape, hence the name 'cruciate'. 'cruciate'.

The role of the Anterior Cruciate Ligament is to The role of the Anterior Cruciate Ligament is to prevent forward movement of the Tibia from prevent forward movement of the Tibia from underneath the femur. The Posterior Cruciate underneath the femur. The Posterior Cruciate Ligament prevents movement of the Tibia in a Ligament prevents movement of the Tibia in a backwards direction. backwards direction.

Together these two ligaments are vitally important Together these two ligaments are vitally important to the stability of the knee joint, especially in to the stability of the knee joint, especially in contact sports and those that involve fast changes contact sports and those that involve fast changes in direction and twisting movements. in direction and twisting movements.

How does a torn ACL occur?How does a torn ACL occur?

A A torn ACLtorn ACL or or ACL injuryACL injury is a relatively common is a relatively common

knee injury amongst sports people. A torn ACL knee injury amongst sports people. A torn ACL

usually occurs through a twisting force being usually occurs through a twisting force being

applied to the knee whilst the foot is firmly planted applied to the knee whilst the foot is firmly planted

on the ground or upon landing. A torn ACL can also on the ground or upon landing. A torn ACL can also

result from a direct blow to the knee, usually the result from a direct blow to the knee, usually the

outside, as may occur during a football or rugby outside, as may occur during a football or rugby

tackle. This injury is sometimes seen in tackle. This injury is sometimes seen in

combination with a medial combination with a medial meniscusmeniscus tear and tear and MCLMCL

injury, which is termed injury, which is termed O’Donohue’s triad. O’Donohue’s triad.

(unhappy triad)(unhappy triad)

““Unhappy Triad”Unhappy Triad”

ANTERIOR CRUCIATE ANTERIOR CRUCIATE LIGAMENT INJURYLIGAMENT INJURY

OVERVIEW OF INJURYOVERVIEW OF INJURY

Posterior Cruciate LigamentPosterior Cruciate Ligament

Injury to PCLInjury to PCL The incidence of injuries of the PCL is less than The incidence of injuries of the PCL is less than

that of thethat of theanterioranterior cruciate ligament cruciate ligament. This is . This is mainly due to the greater thickness and strength mainly due to the greater thickness and strength of the PCL. Nevertheless, the most common way of the PCL. Nevertheless, the most common way in which the PCL is injured is by direct impact to in which the PCL is injured is by direct impact to the front of the tibia itself, usually when the knee the front of the tibia itself, usually when the knee is bent. This may occur in a front-on tackle or is bent. This may occur in a front-on tackle or collision or when falling with the knee bent. The collision or when falling with the knee bent. The injury is commonly associated with injuries to injury is commonly associated with injuries to other structures in the rear compartment of the other structures in the rear compartment of the knee joint such as knee joint such as lateral meniscus tearslateral meniscus tears. In . In addition the articular cartilage may also be addition the articular cartilage may also be damaged.damaged.

ILLUSTRATIONILLUSTRATION

ligament sprainsligament sprains The most common knee injuries in contact The most common knee injuries in contact

sports are sports are ligament sprainsligament sprains , which occur , which occur when the foot is fixed in the ground . If a when the foot is fixed in the ground . If a force is applied against the knee when the force is applied against the knee when the foot cannot move, ligament injuries are foot cannot move, ligament injuries are likely to occur. The tibial and fibular likely to occur. The tibial and fibular collateral ligaments (collateral ligaments (TCL and FCLTCL and FCL) are ) are tightly stretched when the leg is extended, tightly stretched when the leg is extended, normally preventing disruption of the sides normally preventing disruption of the sides of the knee joint.of the knee joint.

The firm attachment of the The firm attachment of the TCLTCL to the to the medial meniscusmedial meniscus is of considerable clinical is of considerable clinical significance because tearing of this significance because tearing of this ligament frequently results in concomitant ligament frequently results in concomitant tearing of the medial meniscus. tearing of the medial meniscus.

oVERVIEW OF MENISCI

MENISCUS DEGENERATIONMENISCUS DEGENERATION

degenerative tears degenerative tears seen in patients seen in patients with early signs of with early signs of wear and tear in wear and tear in the knee.the knee.

TIBIATIBIA Medial boneMedial bone of leg of leg After femur longest After femur longest

bonebone Tibia has a proximal Tibia has a proximal

end, shaft and distal endend, shaft and distal end The medial side of the The medial side of the

distal end projects distal end projects downwards and forms downwards and forms medial malleolusmedial malleolus

Anterior borderAnterior border of the of the shaft is most prominent, shaft is most prominent, sharp and sub-sharp and sub-cutaneouscutaneous

PROXIMAL ENDPROXIMAL END

It is expanded and has a medial condyle, It is expanded and has a medial condyle, lateral condyle, intercondylar area and lateral condyle, intercondylar area and tibial tuberositytibial tuberosity

Right Tibia Fibula

Medial condyleMedial condyle Is larger than the Is larger than the

lateral condylelateral condyle Doesn’t overhang so Doesn’t overhang so

much as the lateral much as the lateral condyle on posterior condyle on posterior aspectaspect

The articular surface is The articular surface is oval in outline and oval in outline and concave in all concave in all diametersdiameters

Its lateral border Its lateral border projects upwards projects upwards forming an elevation forming an elevation called medial called medial intercondylar tubercleintercondylar tubercle

Left Tibia (Anterior View)

Lateral condyleLateral condyle It overhangs the It overhangs the

shaft especially at shaft especially at posterolateral part posterolateral part

A small circular facet A small circular facet for articulation with for articulation with upper end of fibula upper end of fibula

Articular surface is Articular surface is nearly circular nearly circular slightly hollowed in slightly hollowed in its central partits central part

Its medial border Its medial border extends upwards extends upwards forming an elevation forming an elevation called called lateral lateral intercondylar intercondylar tubercletubercle Left Tibia Fibula (Posterior View)

Inter-condylar areaInter-condylar area

It is a roughened area It is a roughened area on the superior surface on the superior surface between the between the articulating surface of articulating surface of the two condylesthe two condyles

The area is narrowed in The area is narrowed in its middle part, its middle part, elevated to form the elevated to form the intercondylar intercondylar eminenceeminence

Intercondylar Intercondylar eminence is flanked by eminence is flanked by the medial and lateral the medial and lateral intercondylar tuberclesintercondylar tubercles

Left Tibia Fibula (Posterior View)

Tibial tuberosityTibial tuberosity

Present at the upper end of Present at the upper end of the anterior border of the the anterior border of the shaftshaft

It is divided into upper It is divided into upper smooth and lower smooth and lower roughened regionroughened region

The upper part has The upper part has attachment of attachment of ligamentum ligamentum patellaepatellae

The lower part of the The lower part of the tuberosity is tuberosity is subcutaneoussubcutaneous

Above the tuberosity deep Above the tuberosity deep infrapatellar bursainfrapatellar bursa present present between the bone and between the bone and ligamentum patellaeligamentum patellae

Left Tibia (Anterior View)

SHAFTSHAFT

It is triangular in It is triangular in sectionsection

Three borders Three borders (anterior, medial (anterior, medial and lateral or and lateral or interosseous) interosseous)

Three surfaces Three surfaces (lateral, medial and (lateral, medial and posterior)posterior)

Tibia Fibula Right Leg Cross section (Inferior view)

BORDERSBORDERSAnterior borderAnterior borderMedial borderMedial border InterosseousInterosseous

borderborder

SURFACESSURFACES

• Lateral surfaceLateral surface• Medial surface Medial surface

(sub-cutaneous)(sub-cutaneous)• Posterior surface Posterior surface

(soleal line) (soleal line)

DISTAL ENDDISTAL END

IIt is slightly expanded t is slightly expanded and projected medially and projected medially to form to form medial medial malleolusmalleolus. It has five . It has five surfacessurfaces

Anterior surfaceAnterior surfaceMedial surfaceMedial surfaceLateral surface- Lateral surface-

fibular notch fibular notch Inferior surfaceInferior surfacePosterior surface-Posterior surface-

groovegroove

Distal End of Right Tibia (Anterior View)

Muscular Muscular attachmentsattachments

Anterior aspect

Posterior aspect

OSSIFICATION OF TIBIA

Tibia ossifies from Tibia ossifies from one one primaryprimary and and two secondary two secondary centrescentres

Primary centerPrimary center appears appearsin the shaft doing the in the shaft doing the seventhseventhweekweek of intra-uterine life of intra-uterine life

First secondary centerFirst secondary center for forthe upper end appears the upper end appears just before just before birthbirth and fuses with the shaft at and fuses with the shaft at 16-1816-18 years years

Second secondarySecond secondary center for the center for the lower endlower end appears during the appears during thefirst year, forms the medial malleolusfirst year, forms the medial malleolusby the by the seventhseventh and joins the shaft in and joins the shaft in about about 16-18 years16-18 years

Stages in ossification of tibia

Genu Valgum and Genu Genu Valgum and Genu VarumVarum

The femur is placed diagonally within the thigh, The femur is placed diagonally within the thigh, whereas the tibia is almost vertical within the leg, whereas the tibia is almost vertical within the leg, creating an angle at the knee between the long creating an angle at the knee between the long axes of the bones . The angle between the two axes of the bones . The angle between the two bones, referred to clinically as thebones, referred to clinically as the Q-angleQ-angle,, (10)is (10)is assessed by drawing assessed by drawing a line from the ASIS to the a line from the ASIS to the middle of the patella and extrapolating a second middle of the patella and extrapolating a second (vertical) line passing through the middle of the (vertical) line passing through the middle of the patella and tibial tuberosity .patella and tibial tuberosity . The Q-angle is The Q-angle is typically greater in adult females, owing to their typically greater in adult females, owing to their wider pelves. When normal, the angle of the femur wider pelves. When normal, the angle of the femur within the thigh places the middle of the knee joint within the thigh places the middle of the knee joint directly inferior to the head of the femur when directly inferior to the head of the femur when standing, centering the weight-bearing line in the standing, centering the weight-bearing line in the intercondylar region of the knee . intercondylar region of the knee .

Genu varum Genu Genu varum Genu valgumvalgum


A A medial angulationmedial angulation of the leg in relation to of the leg in relation to

the thigh, in which the femur is abnormally the thigh, in which the femur is abnormally

vertical and the Q-angle is small, is a vertical and the Q-angle is small, is a

deformity called deformity called genu varumgenu varum (bowleg)(bowleg) that that

causes unequal weight-bearing: Excess causes unequal weight-bearing: Excess

pressure is placed on the medial aspect of the pressure is placed on the medial aspect of the

knee joint, which results in knee joint, which results in arthrosisarthrosis

(destruction of knee cartilages), and the (destruction of knee cartilages), and the

fibular collateral ligament is overstressed.fibular collateral ligament is overstressed. ..


. A . A lateral angulationlateral angulation of the leg (large Q-angle, >17°) in of the leg (large Q-angle, >17°) in

relation to the thigh (exaggeration of the knee angle) is relation to the thigh (exaggeration of the knee angle) is

called called genu valgumgenu valgum (knock-knee) (knock-knee) . Because of the . Because of the

exaggerated knee angle in genu valgum, the weight-exaggerated knee angle in genu valgum, the weight-

bearing line falls lateral to the center of the knee. bearing line falls lateral to the center of the knee.

Consequently, the tibial collateral ligament is Consequently, the tibial collateral ligament is

overstretched, and there is excess stress on the lateral overstretched, and there is excess stress on the lateral

meniscus and cartilages of the lateral femoral and tibial meniscus and cartilages of the lateral femoral and tibial

condylescondyles

The patella, normally pulled laterally by the tendon of the The patella, normally pulled laterally by the tendon of the

vastus lateralis, is pulled even farther laterally when the leg vastus lateralis, is pulled even farther laterally when the leg

is extended in the presence of genu valgum so that its is extended in the presence of genu valgum so that its

articulation with the femur is abnormal.articulation with the femur is abnormal.

Development of limbsDevelopment of limbs

ReferencesReferences

Gray’s Anatomy-40Gray’s Anatomy-40thth edition edition Macmann’s Atlas of AnatomyMacmann’s Atlas of Anatomy Atlas of Human Anatomy, Frank H.Netter,M.D.Atlas of Human Anatomy, Frank H.Netter,M.D. Clinical Oriented Anatomy KLM 6Clinical Oriented Anatomy KLM 6thth edition edition Goggle ChromeGoggle Chrome

osteology lower limb,by dr iram

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