Osteology of Femur & Tibia

Dr Iram Iqbal
 Sequence
 G features and attachments of Femur
 Ossification and blood supply of femur
 Applied anatomy
 G features and attachments of Tibia
 Ossification and blood supply of
 Applied anatomy
 Development
 Conclusion
 References
 FEMUR
 Longest and
strongest bone in
human body
 Two ends
(proximal and
distal) and shaft
 Shaft runs
obliquely from
proximal to distal
end
Right Femur (Anterior View)
 FEMORAL HEAD

1. Directed medially,
upwards and slightly
forwards
• Articulates with the
acetabulum to form
hip joint
• A roughened pit is
situated just below
and behind the
centre of the head
called fovea
Left Femur (Posterior View)
 1.FEMORAL NECK

• It is about 5 cm long
• It connects the head to the
shaft at an angle of(120
-135°) (angle of inclination
or neck-shaft angle)
• Neck–shaft angle facilitates
movements at the hip joint
• Femoral neck has two
borders and two surfaces
• Upper & Lower border
• Anterior & Posterior
surface

Left Femur (Posterior View)

°(Angle Of Inclination Or Neck-shaft Angle)

( Torsion Angle Of Femur)

 2. FEMORAL NECK
 The upper border is
concave and meets the
shaft at the greater
trochanter
 The lower border is
straight and meets the
shaft near the lesser
trochanter
 The anterior surface is
flat and meets the
shaft at the inter-
trochanteric line
 The posterior surface
is convex and meets
the shaft at the inter- Left Femur (Posterior View)
trochanteric crest
 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 Left Femur (Posterior View)
 4. LESSER TROCHANTER

 A conical
posteromedial
projection of the
shaft
 Its anterior
surface is rough,
and posterior
surface at the
distal end of the
inter-trochanteric
crest is smooth Left Femur (Posterior View)
5.INTER-TROCHANTERIC LINE
• A prominent ridge
at the junction of
the anterior
surface of the
neck and shaft
• It descends
medially and
continuous below
with the spiral line
in front of the
lesser trochanter
Left Femur (Anterior View)
6.INTER-TROCHANTERIC CREST

. Smooth ridge at the

junction of
posterior surface of
neck with the shaft
 A little above its
centre there is a
low, rounded
quadrate tubercle

Left Femur (Posterior View)

 B. SHAFT
Convex forwards,
narrowest centrally
Directed obliquely
downwards and
medially
In the upper 1/3 of
the shaft,the two
lips of the linea
aspera diverge
Four surfaces in
upper third, Three in
middle third, and
four in lower third
Right Femur (Posterior View)
 Right Femur (Inferior View)
F. DISTAL END

 It consists of two massive condyles (a medial and a lateral

condyle), inter-condylar fossa and a large articular surface
 Anteriorly the condyles unite and continue into the shaft
 Posteriorly they are separated by a deep inter-Condylar fossa
 DISTAL END
 The articular surface
forms a broad area, like
an inverted U and is …
divisible into patellar and
tibial surface

 The patellar surface

extends over the
anterior surface of both
condyles but more on the
lateral condyle
 It is concave from side
to side

 The tibial surface covers

the inferior and
posterior surfaces of Distal End Left Femur
both the condyles
 It is separated
posteriorly by
intercondylar fossa and
merges anteriorly with
the patellar surface
 Medial condyle has a bulging
on convex medial aspect that
can be palpated
 Its uppermost part has a Right Femur (Inferior View)
small projection called
adductor tubercle
 Below and little in front of
adductor tubercle is medial
epicondyle
 Lateral condyle is not so
prominent as the medial
condyle but is stouter and
stronger
 The most prominent point on
its lateral aspect is is the
lateral epicondyle
 Intercondylar fossa
Right Femur (Posterior View)
Muscular attachments
OSSIFICATION OF FEMUR
 Femur ossifies from five centers
(one primary in the shaft, and four
secondary- each in head, greater
trochanter, lesser trochanter
and distal end)
 Other than the clavicle, it is the first
long bone to ossify
 The primary center for the shaft
appears in the 7th week of intra
-uterine life
 The secondary center for the lower
end at the end of the 9th month of
intra-uterine life
 The secondary center
for the head appears
during the first 6
months of life

 Secondary center for

the greater trochanter
appears during the 4th
year
 And for the lesser
trochanter during the
12th year
 Blood supply
 Vascular supply blood supply of the femoral head is
derived from an arterial ring around the neck, just
outside the attachment of the fibrous capsule,
constituted by the medial and lateral circumflex
arteries with minor contributions from the superior
and inferior gluteal vessels. From this ring, ascending
cervical branches pierce the capsule to ascend the
neck beneath the reflected synovial membrane. These
vessels become the retinacular arteries and form a
sub synovial intra-articular ring. Here the vessels are
at risk with a displaced fracture of the femoral neck.
Interruption of blood supply in this way can lead to
avascular necrosis of the femoral head. If the
fracture is intra-articular then not only is the
interosseous blood supply damaged but the
retinacular vessels can also be vulnerable. If the
fracture is extra capsular, the retinacular vessels will
remain intact and avascular necrosis of the femoral
head does not occur.
Blood supply of head of femur
 Clinical Anatomy
 The distal end of the femur is the only epiphysis in
which ossification constantly starts just before
birth, a most reliable indicator that a dead newborn
child was viable
 Since the growth in length takes place chiefly from
the lower epiphysial cartilage so surgeon needs to be
careful
 Lower epiphyseal line passes through the adductor
tubercle
 Neck represents the upper end of shaft b/c it
ossifies from the primary centre.
 injuries
 Below the age of 16 there is spiral fracture of the
shaft
 Bucket handle tear of the medial meniscus b/e the
age of 14-40 yrs
 Over 60 fracture of the femoral neck is common
because of osteoporotic changes in ageing bones.
Women are more liable, their bones being lightly built
 Pott,s fracture of the leg b/e the age of 40-60
 Avascular necrosis of head of femur in intra-articular
displaced fracture of femoral neck
BUCKET HANDLE Spiral fracture of
TEAR the shaft
 "Bucket-handle Tear”
 . These large tears tend to occur in younger
patients, and are always traumatic injuries.
 bucket-handle tear is a 
tear around the rim of the meniscus, causing
the central portion (the bucket-handle) to
displace into the joint. These types of tears
generally involve large amounts of the
meniscus, and are often amenable tomeniscus
repair (rather than removal of the meniscus).
 Patients with these bucket-handle tears may
have limited motion of the knee joint if the
meniscus tear is large enough to get caught
inside the knee.
Pott fracture, dislocation of ankle joint
 A Pott fracture-
dislocation of the ankle
occurs when the foot is
forcibly averted. (combined
abduction external rotation
from an eversion force)
 This action pulls on the
extremely strong medial
ligament, often tearing off
the medial malleolus.
 The talus then moves
laterally, shearing off the
lateral malleolus or, more
commonly, breaking the
fibula superior to the
tibiofibular syndesmosis.
 If the tibia is carried
anteriorly, the posterior
margin of the distal end of
the tibia is also sheared off
by the talus.
 "trimalleolar fracture"
 The combined fracture of the medial
malleolus, lateral malleolus, and the posterior
margin of the distal end of the tibia is known
as a "trimalleolar fracture.“In a "trimalleolar
fracture" the posterior distal end of the tibia
is erroneously labeled as a malleolus.
Avascular necrosis of head of
femur
 Coxa Vara and Coxa Valga
The angle of inclination varies with age, sex,
and development of the femur (e.g.,
consequent to a congenital defect in
ossification of the femoral neck). It also may
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, the condition is . Coxa valga causes
a mild passive abduction of the hip.
Coxa Vara and Coxa Valga
 Fracture of femur
 Fracture of upper end (neck)
– Intracapsular
 Sub capital
 Trans cervical
 basal
– Extra capsular
 Intrtrochanteric
 Fracture of shaft
– Type I - Spiral or transverse (most common)
– Type II - Comminuted
– Type III - Open
 Associated injuries are common.
Classification based on appearance
of hip on AP view of Xray

– stageI : incomplete fracture of the neck

(so-called abducted or impacted)
– stage II : complete without displacement
– stage III: complete with partial
displacement:
– stage IV : this is a complete femoral neck
fracture with full displacement:
OVERVIEW OF LIGAMENTS
 The knee is stabilized by four main ligaments: 2
collateral ligaments (medial and lateral) and 2
cruciate ligaments both anterior (front) and posterior
(back).
 The cruciate ligaments attach to the femur (thigh
bone) and travel within the knee joint to the upper
surface of the tibia (shin bone). The ligaments pass
each other in the middle of the joint forming a cross
shape, hence the name 'cruciate'. 
 The role of the Anterior Cruciate Ligament is to
prevent forward movement of the Tibia from
underneath the femur. The Posterior Cruciate
Ligament prevents movement of the Tibia in a
backwards direction.
 Together these two ligaments are vitally important to
the stability of the knee joint, especially in contact
sports and those that involve fast changes in
direction and twisting movements.
 How does a torn ACL occur?
 A torn ACL or ACL injury is a relatively common knee
injury amongst sports people. A torn ACL usually
occurs through a twisting force being applied to the
knee whilst the foot is firmly planted on the ground
or upon landing. A torn ACL can also result from a
direct blow to the knee, usually the outside, as may
occur during a football or rugby tackle. This injury is
sometimes seen in combination with a medial meniscus
 tear and MCL injury, which is termed O’Donohue’s
triad. (unhappy triad)
“Unhappy Triad”
ANTERIOR CRUCIATE
LIGAMENT INJURY
OVERVIEW OF INJURY
Posterior Cruciate Ligament
 Injury to PCL
 The incidence of injuries of the PCL is less than that
of theanterior cruciate ligament. This is mainly due to
the greater thickness and strength of the PCL.
Nevertheless, the most common way in which the PCL
is injured is by direct impact to the front of the tibia
itself, usually when the knee is bent. This may occur
in a front-on tackle or collision or when falling with
the knee bent. The injury is commonly associated with
injuries to other structures in the rear compartment
of the knee joint such as lateral meniscus tears. In
addition the articular cartilage may also be damaged.
ILLUSTRATION
 ligament sprains
 The most common knee injuries in contact
sports are ligament sprains , which occur when
the foot is fixed in the ground . If a force is
applied against the knee when the foot cannot
move, ligament injuries are likely to occur.
The tibial and fibular collateral ligaments
(TCL and FCL) are tightly stretched when the
leg is extended, normally preventing
disruption of the sides of the knee joint.
 The firm attachment of the TCL to the medial
meniscus is of considerable clinical
significance because tearing of this ligament
frequently results in concomitant tearing of
the medial meniscus.
oVERVIEW OF MENISCI
 Meniscal tears
 Meniscal tears usually involve the medial meniscus. The lateral
meniscus does not usually tear because of its mobility.
 Pain on lateral rotation of the tibia on the femur indicates
injury of the lateral meniscus , whereas pain on medial rotation
of the tibia on the femur indicates injury of the medial
meniscus
 Most meniscal tears occur in conjunction with TCL or ACL tears.
Peripheral meniscal tears can often be repaired or may heal on
their own because of the generous blood supply to this area.
Meniscal tears that do not heal or cannot be repaired are usually
remove.
 Knee joints from which the menisci have been removed suffer
no loss of mobility; however, the knee may be less stable and the
tibial plateaus often undergo inflammatory reactions.
MENISCUS DEGENERATION
 degenerative tears
seen in patients with
early signs of wear
and tear in the knee.
 TIBIA
 Medial bone of leg
 After femur longest
bone
 Tibia has a proximal end,
shaft and distal end
 The medial side of the
distal end projects
downwards and forms
medial malleolus
 Anterior border of the
shaft is most prominent,
sharp and sub-cutaneous
PROXIMAL END

It is expanded and has a medial condyle,

lateral condyle, intercondylar area and tibial
tuberosity

Right Tibia Fibula

Medial condyle
 Is larger than the
lateral condyle
 Doesn’t overhang so
much as the lateral
condyle on posterior
aspect
 The articular surface is
oval in outline and
concave in all diameters
 Its lateral border
projects upwards
forming an elevation
called medial
intercondylar tubercle

Left Tibia (Anterior View)

Lateral condyle
 It overhangs the
shaft especially at
posterolateral part
 A small circular facet
for articulation with
upper end of fibula
 Articular surface is
nearly circular slightly
hollowed in its central
part
 Its medial border
extends upwards
forming an elevation
called lateral
intercondylar tubercle
Left Tibia Fibula (Posterior View)
 Inter-condylar area
 It is a roughened area
on the superior surface
between the articulating
surface of the two
condyles
 The area is narrowed in
its middle part, elevated
to form the
intercondylar eminence
 Intercondylar eminence
is flanked by the medial
and lateral intercondylar
tubercles
Left Tibia Fibula (Posterior View)
 Tibial tuberosity
 Present at the upper end of
the anterior border of the
shaft
 It is divided into upper
smooth and lower roughened
region
 The upper part has
attachment of ligamentum
patellae
 The lower part of the
tuberosity is subcutaneous
 Above the tuberosity deep
infrapatellar bursa present Left Tibia (Anterior View)
between the bone and
ligamentum patellae
 SHAFT

 It is triangular in
section
 Three borders
(anterior, medial and
lateral or
interosseous)
 Three surfaces
(lateral, medial and
posterior)
Tibia Fibula Right Leg Cross section
(Inferior view)
 BORDERS
 Anterior border

 Medial border

 Interosseous

border

SURFACES

• Lateral surface
• Medial surface (sub-
cutaneous)
• Posterior surface
(soleal line)
 DISTAL END
It is slightly expanded
and projected medially
to form medial
malleolus. It has five
surfaces
 Anterior surface
 Medial surface
 Lateralsurface-
fibular notch
 Inferior surface Distal End of Right
 Posterior surface- Tibia (Anterior View)

groove
 Muscular
attachments

Anterior Posterior
aspect
OSSIFICATION OF TIBIA
 Tibia ossifies from one
primary and two secondary
centres
 Primary center appears
in the shaft doing the seventh
week of intra-uterine life
 First secondary center for
the upper end appears just before
birth and fuses with the shaft at
16-18 years
 Second secondary center for the
lower end appears during the
first year, forms the medial malleolus
by the seventh and joins the shaft in
about 16-18 years
Stages in ossification of tibia
 Genu Valgum and Genu Varum
 The femur is placed diagonally within the thigh,
whereas the tibia is almost vertical within the leg,
creating an angle at the knee between the long axes
of the bones . The angle between the two bones,
referred to clinically as the Q-angle, (10)is assessed
by drawing a line from the ASIS to the middle of the
patella and extrapolating a second (vertical) line
passing through the middle of the patella and tibial
tuberosity . The Q-angle is typically greater in adult
females, owing to their wider pelves. When normal,
the angle of the femur within the thigh places the
middle of the knee joint directly inferior to the head
of the femur when standing, centering the weight-
bearing line in the intercondylar region of the knee .
Genu varum Genu valgum
 Genu Valgum and Genu Varum
 A medial angulation of the leg in relation to
the thigh, in which the femur is abnormally
vertical and the Q-angle is small, is a
deformity called genu varum (bowleg) that
causes unequal weight-bearing: Excess
pressure is placed on the medial aspect of the
knee joint, which results in arthrosis
(destruction of knee cartilages), and the
fibular collateral ligament is overstressed.
 .
 Genu Valgum and Genu Varum
 . A lateral angulation of the leg (large Q-angle, >17°) in relation
to the thigh (exaggeration of the knee angle) is called genu
valgum (knock-knee) . Because of the exaggerated knee angle in
genu valgum, the weight-bearing line falls lateral to the center
of the knee. Consequently, the tibial collateral ligament is
overstretched, and there is excess stress on the lateral
meniscus and cartilages of the lateral femoral and tibial
condyles
 The patella, normally pulled laterally by the tendon of the
vastus lateralis, is pulled even farther laterally when the leg is
extended in the presence of genu valgum so that its articulation
with the femur is abnormal.
Development of limbs
 References
 Gray’s Anatomy-40th edition
 Macmann’s Atlas of Anatomy
 Atlas of Human Anatomy, Frank H.Netter,M.D.
 Clinical Oriented Anatomy KLM 6th edition
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