the

Proximal femur (anatomy)

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this week we is going to be looking at

the proximal femur

oh boy only the proximal femur you say

well cut the reasons I had a question on

the lesser trochanter in a recently exam

and students didn't do very well at it

so I thought I'd spend time reviewing it

revising it and also the proximal femur

is a hip thing whereas the distal femur

is a knee thing and we looked at the

Kinney a few months ago we even looked

at the patella in detail so I thought

that if we focus on just the proximal

femur we can focus on the important bits

and I can like I can bring it all

together so it was super simple

you guys get his super nails and it's

gonna be super easy right

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also if the longest bone in the body so

I think we're allowed to break it up

right the femur is a little bit like the

humerus in there it's the other big ball

and socket joint got a big ball and

socket joint of the glenn eau claire no

humor or doing I was teaching shoulder

this week anyway glenohumeral joint and

we got this nice deeper ball and socket

joint at the hip and the femurs forming

the socket of it but also in the humerus

we see a couple of two because the

Greater and Lesser tubercles and we look

at the femur we also see a couple of try

Cantor's which are the same idea and

knowing where these lumpy bony bits are

and the groups of muscles that attach to

them we can then see how those muscles

move the femur and why the femur is

shaped as it is mechanical advantage

leverage stuff matter all right

now this isn't a terribly detailed femur

I've got a better one on on this friend

but there are you know if you look in

the textbooks and the assays you'll see

a huge amount of detail here and I

mentioned some of that detail but the

main aim here is to look at the big bits

all right okay then so if we start at

the proximal most proximal bit here this

is the the head of the femur and this is

the neck now if we look at this in situ

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we can see that the head of the femur is

the ball of the ball and socket and the

socket is the acetabulum of the pelvis

nest ablum is made up of the three bones

of the pelvis right so that's our ball

and socket joint now it's quite a deep

ball and socket joint which means it's

quite a strong joint

unlike the shoulder girdle which is or

the shoulder glenohumeral joint which is

a little bit weaker it's more open but

this is you know the reason the femur is

such a big bow and the reason this joint

is such a big chunky joint is because of

course is taking our entire body weight

but there are a range

movements hit the ball and socket joint

allows which we should review before we

talk about how all this moves right so

we've got abduction of the femur at the

hip joint and we've got adduction of the

femur or the thigh we've got flexion of

the hip joint and we've got extension of

the hip joint

so that's flexion and extension but then

we've also got medial rotation whoo

medial rotation and lateral rotation

right so me me is a bit limited because

he's gonna spiky boots but need your

rotation and lateral rotation medial

rotation and the lateral rotation of the

femur so these bony bits on the proximal

part of femur are enabling all of that

and the big muscles doing it as well

medial rotation lateral rotation medial

rotation lateral rotation my hip flexors

and my bits of my lateral rotators

bouldering last week they get a better

but I still feel a bit of that and then

of course we got circumduction but but

they're like circumduction now so it's a

nice it would be the really nice ball

covered in articular cartilage the one

thing there's a little depression on the

head of the femur called the fovea

which is actually where the ligaments of

the femur

oh there's one on there here we go that

depression there and that's where the

ligaments of the femur helps hold the

joint together we only have some

nutrient arteries running through there

so that's the head of the femur and then

we have the neck of the femur now the

thing about the neck of the femur is

when somebody talks about a hip fracture

they they're generally talking of a

fractured neck of femur if this bit here

a fracture of the pelvis is a pelvic

fracture a fracture of the hip a

fractured hip is usually a fracture of

the neck of the femur here and because

of the big muscles that are attaching

around here this tends to be not a good

thing and the weight-bearing thing of it

so for acting like a femur is is far

more common in the elderly

it happens in young people with like

really severe trauma like car crashes

and that's all thing and the synovial

capsule is actually extending over the

neck of the femur which means that the

reason I don't think there's a normal

periosteum and it's within the center of

your fluid so in fact near the healing

of a fractured neck of femur isn't as

great as other regions of the femur and

because of that and because of the fact

that is more commonplace in all the

people and in frail people you have bone

weakness and bone problems it's it's a

it's a fracture that has a really high

mortality rate associated with it it's a

very dangerous fracture because if

you're going to repair it surgically

there are risks and dangers and

recovering from that surgery there's a

big risk of developing deep vein

thrombosis and pulmonary embolisms as

clots form under here and disappear so

it's really not a good thing to break

but the good side is it's a really

really strong bone so it's not an easy

thing to break and this is one of the

reasons why you kind of need to stay

strong as you get older keep your bones

strong and keep your muscles strong keep

your joints good anyway so the neck of

the femur is extending out here and what

it's doing is is is it's pushing the

femur out laterally this part of the

femur and it's pushing it out laterally

and a little bit anteriorly as well so

the angle created here is called the

angle of inclination so that angle there

is the angle of inclination and it can

be greater or smaller it's it's it

changes between childhood and

adolescence and out

from that sort thing that's if

somebody's talking about the angle of

inclination of FEMA that's what they're

talking about this angle change between

the neck and the diathesis of the femur

down there all right

so neck of the femur now we kind of get

into the interesting bits these big

lumpy bumpy bits here and here this

large lateral lump is the greater

trochanter and this smaller kind of very

posterior lump is the lesser trochanter

now the greater trochanter you can

palpate palpate on yourself right out

here that bony prominence that you're

feeling it's the greater trochanter and

look as you move your femur around you

can feel the greater trochanter move you

can rotate your femur you can do all

those things of your femur and feel the

greater trochanter move around and also

you can feel the muscles are attached to

it doing different things depending on

how you're moving your pelvis and your

femurs right we can see on here as well

take off go to its Maximus

so that bit your palpating is here so

there's the greater trochanter there and

we can see all of these muscles running

out to attach to it so we've got this is

gluteus medius and minimus running down

to the top of the greater trochanter

here and the bit at the top of the

greater trochanter gets called the

tubercle and then we've got these

smaller muscles running from the pelvis

out laterally to the greater trochanter

and those are the lateral rotators of

the hips of the obturator muscles that

can Mele muscles piriformis and now

sorting right and then we've got

quadratus femoris they're the leather

quad directed rectangular muscle there

and right let's have a look on this guy

so we're looking at this from the

anterior perspective he's the greater

trochanter there that you were palpating

there's this tubercle at the top so

that's a big obvious thing so head neck

greater trochanter now the lesser

trochanter

you can just see it it's very much a

posterior thing so it's poking around

back there now greater trochanter up

here we've got the gluteus medius and

minimus running down from the pelvis

here to the greater trochanter which

means when they contract they do this so

they're pulling on the greater

trochanter to abduct the femur at the

hip joint

now there's other muscles so the we've

got from here well from inside the

pelvis they're running around there to

the greater trochanter so when they

contract they pull the greater

trochanter that way so do you see that's

a lateral rotation of the femur and if

this is flexed then they kind of do

anyway so the purpose of the greater to

counter the purpose of the neck these

are muscle attachments and the purpose

of the neck of the femur is to push this

muscle this this muscle attachment point

out away from the pelvis to give them a

canakkale advantage to give us bipedal

locomotion all those things we do when

we're walking around so without the neck

of the femur doing that none of this

would work so a greater trochanter

abduction from gluteus medius and

minimus and the lateral rotation from

the six lateral rotators around there

right now the lesser trochanter well if

we look posteriorly something else you

might come across is the is the

trochanteric phosphorus there's this

fossa in here and that trochanteric so

you might hear about the lateral

rotators or many many other Kamalei

muscles and the opportunity of muscles

inserting there that's part of the

greater trochanter so it's kind of all

the same thing there's just a little bit

of a fossa a bit there

now there's the lesser trochanter there

so we're looking at the posterior femur

and the the lesser trochanter

this is where some of the hip flexors

attached to so we've got here's the

ilium

we've got iliacus and we've got psoas

major running down from from here and

they come together to form iliopsoas so

iliopsoas runs over here and inserts

into the lesser trochanter and this is

yeah yeah yogi your main hip flexor so

when when iliacus and psoas major

contract they pull on the lesser

trochanter and they give flexion of the

hip they give flexion of the femur at

the hip joint so that's what the letters

are counter for so let's the trochanter

is in the active and psoas major greater

two counters all those other must have

you talked about and that's that's most

of it that's the really important stuff

in the proximal femur a couple of other

footnotes not really near the foot but

whatever into trochanteric crest and

intertrochanteric line two other terms

you might come across they're two

different things they're both in beti

between the two trochanters

now postie really there's the greater

trochanter

there's the lesser trochanter and

there's this nice big thick ridgey crest

postie really so that's the

intertrochanteric crest anteriorly it's

a bit more feeble it's feebler so we

have an intertrochanteric line

anteriorly that's what those two things

refer to we also talked about a quadrate

tubercle so we were talking about

quadratus femoris that that muscle going

across here and quadratus femoris causes

another little bump here which is the

quadrate tubercle and then we're seeing

this line running down here down the

diaphysis which is the linear

aspera it's not in today's business

because it's it's like it's not proximal

femur but up here there's a lump

posteriorly and that's the gluteal

tuberosity for gluteus maximus because

gluteus maximus is a powerful extensor

of a hip joint which is what I took off

up here isn't it so gluteus maximus

actually inserts most of these fibers

into the

and the connective tissue of the Legba

sends a bunch of its fibers into the

posterior femur and where it attaches as

a bit of a lump and that's the gluteal

tuberosity anything else it's really

important that that is that is the nuts

and bolts of it so proximal femur it's

got a head it's got a neck it's got a

greater trochanter it's got a lesser

trochanter the greater trochanter you've

got gluteus medius and minimus attached

to it for abduction

you've got the lateral rotators attached

to it the latter II rotate the femur was

the lesser trochanter you have the hip

flexors iliopsoas running over and

attaching to that and that is your

proximal femur all right okay still

don't know why while I was so awkward in

the exam you're not going to rephrase my

question a bit differently or something

like that for another exam on Monday

that's the first is over and they're

busy revising I hope they do well anyway

if you want to look at the distal femur

go and have a look at our knee video we

talked about how the distal femur

articulates on the tibia and stuff like

that good luck crack on see you next

week

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you

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