LOWER LIMB (2)

HERIN SETIANINGSIH

Regions under the inguinal ligament.

Lacuna musculorum

Boundaries os ilium - popsteriorly lig. inguinale - anteriorly arcus iliopectineus - medially Content

9 m. Iliopsoas 9 n. femoralis 9 n. cutaneus femoris lateralis

Lacuna Vasorum
Boundaries arcus iliopectineus - laterally lig. lacunare lig. inguinale - medially - anteriorly

pecten ossis pubis - posteriorly Content Femoral sheth: a. & v. femoralis n. genitofemoralis (r. femoralis)

Upper Thigh
Canalis femoralis
Boundaries
From anulus femoralis to hiatus saphenus

(1-2 m) triangular section Content

loose connective tissue lymph nodes

Canalis Obturatorius
Boundaries sulcus obturatorius superiorly membrana & mm. obturatorii inferiorly oblique course - 2 m length Content a. et v. obturatoria n. obturatorius

Fascia lata
Ensheaths entirely the thigh muscles. Proximally attached to lig. Inguinale, crista iliaca, symphisis, ischial bone. Posteriorly fuses with gluteal fascia.

Fascia lata
Structures Ligamentum inguinale In trigonum femorale - superficial layer - deep layer (fascia iliopectinea). Hiatus saphenus

Fascia lata
Tractus iliotibialis - lateral on the thigh Septa intermuscularia - septum intermusculare laterale - septum intermusculare mediale - septum intermusculare posterius Fascial beds for -m. sartorius, -m. tensor fasciae latae, -m. gracilis.

Struktur Khusus

Femoral triangle / RELATIONS

Anterior view

Femoral triangle / RELATIONS

Femoral triangle / DEEP VESSELS AND NERVES

Anterior view

1 2

Hip Anastomosis / FEMORAL HEAD ARTERIAL SUPPLY

Lat fem cir a.

Ascending branches, lat fem cir. Anterio-lateral view

Hip collateral circulation / TROCHANTERIC ANASTOMOSIS

Arterial supply to Femoral head Medial Femoral Circumflex artery Lateral Femoral Circumflex artery (acsending br.) Post. obdurator artery via artery of femoral ligament Superior and inferior gluteal arteries

Posterior view

Femoral triangle

Boundaries - bottom - m. iliopsoas and m. pectineus (fossa iliopectinea).

Femoral triangle
Content - a. femoralis

superficial branches:

- epigastrica superficialis - circumflexa ilium superficialis - pudendae externae - a profunda femoris - a. circumflexa femoris medialis et lateralis

deep branches :

- v. femoralis - v. saphena magna - vv. circumflexae - v. profunda femoris femoris - n. femoralis - Motor and sensory for anterior thigh region - for m. pectineus - n. saphenus

Canalis adductorius
Location- from apex of trigonum femorale to hiatus tendineus, opening into fossa poplitea. (15 cm inferior lig. Inguinalis) Parts

Upper subsartorial, 3 walls:

- lateral - m. vastus medialis - post-medial - m. adductor longus et magnus - anterior - m. sartorius et membrana vastoadductoria

Content
- a. femoralis - anteriorly - v. femoralis posteriorly and laterally - n. saphenus - laterally

Canalis adductorius

Regio glutea

Cutaneous nerves

Nn. clunii superiores (L1-L3) Nn. clunii medii (S1-S3) Nn. clunii inferiores N. cutaneus femoris posterior

Muscles
Extensors, abductors and lateral rotators in hip joint.

Muscles

gluteus maximus gluteus medius gluteus minimus piriformis gemellus superior obturatorius internus gemellus inferior obturatorius externus quadratus femoris

Arteries
Branches of a. iliaca interna. Exit through for. ischiadicum major : A. glutea superior A. glutea inferior A. pudenda interna

Nerves
From plexus lumbosacralis : N. gluteus superior (thru for suprapiriformis). For m. tensor fasciae latae. N. gluteus inferior N. ischiadicus N. cutaneus femoris posterior N. pudendus N. to m. quadratus femoris and m. gemellus inferior N. to m. obturatorius internus and m. gemellus superior

POPLITEAL FOSSA

Fossa poplitea
Behind
- the distal femur - knee joint and - proximal tibia. - Apparent in flexion.

Fossa poplitea
Covered by skin and fasciae. Fascia poplitea superficialis fat tissue, v. saphena parva, n. saphenus, n. cutaneus surae medialis. V. saphena parva pierces fascia poplitea profunda and enters v. poplitea. Fascia poplitea profunda covers nervevascular bundle .

Popliteal Fossa

Boundaries: Superior : Semimembranosus and semitendinosus. Inferior : Medial and lateral heads of the gastrocnemius.

SM ST

Biceps Femoris

The Popliteal Fossa

Contents 1. Tibial N., Common Fib. N. Gastrocnemius 2. Popliteal V. 3. Popliteal A. (& Plantaris)

Fossa Poplitea
Bony base Femur condylus medialis condylus lateralis Tibia condylus medialis condylus lateralis Boundaries Upper medial - semitendinosus (ST) Lower medial gastrocnemius caput mediale (MG) Upper medial - biceps femoris (B) Lower medial - gastrocnemius caput laterale (LG)

Fossa Poplitea

Fossa poplitea - bottom fossa poplitea femoris tibia lig. popliteum obliquum m. popliteus

Fossa Poplitea
Contents : - Fat. - Several popliteal lymph nodes. - Popliteal bursa. Superficial to deep : - Tibial nerve. - Popliteal vein. - Popliteal artery. Common peroneal (fibular) nerve. Small saphenous vein.

Fossa Poplitea
Contents: Popliteal artery : Continuation of femoral artery. Begins at adductor hiatus. Ends at lower border of popliteus muscle. Divides into anterior and posterior tibial arteries.

Fossa Poplitea
Contents: Popliteal vein: Formed from venae comitantes of anterior and posterior tibial arteries. Receives lesser saphenous vein. Becomes femoral vein at adductor hiatus.

Fossa Poplitea
Contents: Tibial nerve: Part of sciatic nerve. Supplies posterior thigh and leg. Common peroneal nerve: Part of sciatic nerve. Branches into superficial and deep peroneal (fibular) nerves : Supplies lateral and anterior leg.

Fossa Poplitea
Sural nerve : Arises via : - Communicating branch from tibial nerve. - Communicating branch from common peroneal (fibular) nerve.

Crural Fascia
Continuous with fascia latae. Attachment to anterior and medial borders of tibia : - Continuous with periosteum. - Leaves bare area. Fascia forms retinacula in foot: Superior (extensor) retinaculum : - Proximal to malleoli. - Binds tendons in anterior crural compartment.

Crural Fascia
Fascia forms retinacula in foot : - Inferior (extensor) retinaculum : Y-shaped. - Flexor retinaculum : Binds tendons of the deep posterior compartment. - Superior/inferior peroneal retinacula : Bind tendons of lateral crural compartment.

The Menisci (semilunar cartilages)

Femur

Meniscus (Triangular in X-Section)

Tibia

Functions: Stability : - Deepen articular Patella surfaces of tibia - Compensate for incongruent bone surfaces Shock absorption Distribution of synovial fluid

The Menisci (semilunar cartilages) cont.

Lateral meniscus more mobile than med. popliteal tendon (P) separates it from the lat. collateral ligament (L) A few popleital fibers attach to lateral meniscus and move it

Medial meniscus relatively immobile (fixed) attached to capsule, tibia & medial collateral ligament
L P

The Triad (3 Cs: collateral, cartilage, cruciate)

3. ACL 2. Medial Meniscus

1. Medial Collateral Lig.

Selamat belajar, semoga SUKSES