Joints of the bones of the free lower limb

Joints of the bones of the free lower limb

In the free part of the lower limb, the joints of the femur, leg bones and foot are distinguished.

The continuous connections of the bones of the free lower limb are:

– tibiofibular syndesmosis - a fibrous connection between the fibular notch of the tibia and the articular surface of the base of the ankle of the fibula;

– interosseous membrane of the leg - in the form of a strong connective tissue membrane stretched by the interosseous edges of the tibia and fibula.

Discontinuous connections in the skeleton of the free part of the lower limb are represented by:

– hip joint, art. coxae

;

– knee joint, art. genus

;

– joints of the lower leg bones;

– ankle joint, art. talocruralis

;

– numerous joints in the skeleton of the foot – subtalar, talocaleonavicular, calcaneal-cuboid, etc., as well as tarsometatarsal, metatarsophalangeal and interphalangeal.

Hip joint , art. coxae

(Fig. 4.38, 4.39).

1. Hip joint , art. coxae.

2. Bones forming the joint: pelvic bone, os coxae

and femur,
os femur
;
articular surfaces: the semilunar articular surface of the acetabulum, facies lunata acetabuli
, and the head of the femur,
caput ossis femori.
3. The joint capsule is attached:

– on the pelvic bone – along the edge of the articular labrum, labrum acetabulare

;

– on the femur: in front – along the linea intertrochanterica

;
behind – medial from crista intertrochanterica
;

– the lateral part of the neck remains outside the joint.

4. In appearance – simple, art.simplex.

5. Shape – spherical (bowl-shaped (nut-shaped)), art. cotylica (enarthrosis

).

6. By the number of rotation axes - multi-axis.

7. Movements:

– around the frontal axis – flexion and extension, flexio et extensio

,

– around the sagittal axis – abduction and adduction, abductio et adductio

,

– around a vertical axis – rotation, rotatio

,

– transition from the frontal axis to the sagittal – circular (conical) movement, circumductio.

8. Fixing device:

– iliofemoral ligament, lig.iliofemorale

(Bertini ligament);

– pubofemoral ligament, lig.pubofemorale

;

– ischiofemoral ligament, lig. ischiofemorale

;

– circular zone, zona orbicularis

.

9. Auxiliary apparatus: labrum, labrum acetabulare

;
transverse ligament of the acetabulum, lig.transversum acetabuli
;
ligament of the femoral head, lig.
capitis femoris 10. Blood supply, venous and lymphatic drainage, innervation:

Morpho-functional features. A special feature of the hip joint is the presence of such an auxiliary element as the ligament of the femoral head. lig. capitis femoris. It starts in the lig area. transversum acetabuli between both ends of the fascies lunata acetabuli and, gradually tapering, is attached to the fovea capitis femoris. Its length on average is 2 – 2.5 cm, thickness varies. The ligament of the femoral head is enveloped in a synovial membrane, which rises onto it from the bottom of the acetabulum. It is an elastic pad that softens the shock experienced by the joint, and also serves to conduct blood vessels into the head of the femur. Therefore, if this shell is preserved during fractures of the femoral neck, the head does not die. In addition, this ligament plays an important role during the formation of the hip joint, holding the head of the femur to the acetabulum.

Knee joint, art. genus

(Fig. 4.40-4.44).

1. Knee joint, art. genus

2. Bones forming the joint: femur, os femur,

tibia, os
tibia
, and patella,
patella
; articular surfaces:

– articular surface of the condyles of the femur, facies articularis condyli femoris

and patellar surface
, facies patellaris
;

– upper articular surface of the tibia, facies articularis superior tibiae

;

– articular surface of the patella, facies articularis patellae

.

3. The joint capsule is thin and elastic. The attachment points are as follows:

– on the femur – in front 1 cm above the patella surface; from the side - along the epicondyles, leaving them outside the joint;

- on the tibia and patella - along the edge of the articular surfaces.

4. In appearance – complex, art. composita

;
complex, art.
complexa .

5. Shape – condylar , art. bicondylaris

, or trochlear-rotational,
art.
trochogingymus .

6. According to the number of axis of rotation - biaxial.

7. Movements:

– around the frontal axis: flexion and extension, flexio et extensio;

– around a vertical axis – rotation, rotatio

(in a bent position).

8. Fixing device:

– fibular collateral ligament, lig. collateral fibulare;

– tibial collateral ligament, lig. collateral tibiale

;

– patellar ligament , lig. patellae

;

– oblique popliteal ligament, lig. popliteum obliquum

;

– arcuate popliteal ligament , lig. popliteum arcuatum.

9. Auxiliary apparatus:

Intra-articular cartilage:

– lateral meniscus, meniscus lateralis

;

– medial meniscus, meniscus medialis.

Intra-articular ligaments:

– anterior cruciate ligament, l ig. cruciatum anterius

;

– posterior cruciate ligament, lig. cruciatum posterius

;

– transverse ligament of the knee, lig. transversum genus

.

Fat and synovial folds:

– pterygoid folds, plicae alares

;

– subpatellar synovial fold, plica synovialis infrapatellaris

;

– synovial villi, vili synoviales.

Synovial bursae:

- suprapatellar joint capsule , bursa suprapatellaris

;

– deep subpatellar bursa, bursa infrapatellaris profunda

;

– prepatellar bursa, bursa subcutanea prepatellaris

;

– bursa of the semimembranosus muscle, bursa m. semimembranosi

;

– bursa of the popliteal muscle, bursa m. poplitei

.

Rice. 4.42. Knee joint, art. genus

right. Distal part of the joint (top view).

1 – tuberositas tibiae; 2 – lig. transversum genus; 3 – lig. meniscofemorale anterius; 4 – meniscus lateralis; 5 – lig. cruciatum anterius; 6 – lig. meniscofemorale posterius; 7 – lig. cruciatum posterius; 8 – meniscus medialis.

Morpho-functional features:

– incongruence of articular surfaces;

– the presence of a large number of auxiliary elements:

• lateral and medial menisci – complement the articular surfaces of the tibia and femur, increasing the congruence of these surfaces;

• synovial folds and villi (pterygoid folds, subpatellar synovial fold, synovial villi) – these folds are formed by the synovial membrane of the capsule, contain fatty tissue, protrude into the joint cavity and fill part of the articular cavity, which remains free due to the incongruence of the articular surfaces;

• intra-articular ligaments (anterior and posterior cruciate ligaments) – firmly connect the femur and tibia, crossing each other in the shape of the letter X;

– the structure and location of the ligaments of the knee joint in a person contributes to his long stay in an upright position;

– some synovial bursae (patellar, deep patella, prepatellar bursa, semimembranosus bursa and popliteus bursa) connect to the joint cavity, significantly increasing its volume: the synovial bursae of the knee joint, under the influence of damage, infections and other causes, can become inflamed (bursitis) and be accompanied by accumulation of escudate in its cavities.

10. Blood supply, venous and lymphatic drainage, innervation:

Joints of the leg bones. The bones of the lower leg are connected to each other through discontinuous and continuous connections (Fig. 4.45).

Rice. 4.45. Connections of the bones of the lower leg, right (front view).

1 – lig. capitis fibulae anterius (articulatio tibiofibularis); 2 – tuberositas tibiae; 3 – membrana interossea cruris; 4 – corpus tibiae; 5 – malleolus medialis; 6 – malleolus lateralis; 7 – lig. tibiofibulare anterius (syndesmosis tibiofibularis, articulatio); 8 – corpus fibulae.

Interfibular joint, art. tibiofibularis,

connects the proximal epiphyses of the tibia and fibula.
The joint is flat in shape and allows minor sliding movements. The joint capsule, attached along the edge of the articular surfaces, is strengthened in front by the anterior ligament of the fibula, lig.
capitis fibulae anterius, and the posterior ligament of the head of the fibula,
lig.
capitis fibulae posterius. The distal ends of the tibia bones are connected by the tibiofibular syndesmosis, syndesmosis tibiofibularis.

Anteriorly and posteriorly, this connection is reinforced by the anterior and posterior tibiofibular ligaments,
ligg.
tibiofibularia anterius et posterius. A strong fibrous plate is the interosseous membrane of the leg, membrana interossea cruris,

connects
margo interosseus
of both bones. In the upper and lower parts of the membrane there are openings for the passage of blood vessels and nerves.

1. Interfibular joint, art. tibiofibularis.

2. Bones forming the joint: tibia, tibia

, fibula,
fibula
(discontinuous connection);
the articular surfaces of the joint are: the fibular articular surface, facies articularis fibularis tibiae
, on the tibia and the articular surface of the head on the fibula,
faies articularis capitis fibulae
.

3. The joint capsule is tight, strengthened by the anterior ligament of the head of the fibula, lig. capitis fibulae anterius

, and the posterior ligament of the head of the fibula
, lig.
capitis fibulae posterius .

4. In appearance – simple, art. simplex.

5. Shape – flat, art. plana.

6. By the number of rotation axes - multi-axis.

7. Movement: practically motionless.

8. There is no fixing apparatus, except for the ligaments that strengthen the capsule.

9. There are no auxiliary elements of the joint, except for ligaments.

10. Blood supply, venous and lymphatic drainage, innervation:

Bones and joints of the free lower limb (human anatomy)

The femur (os femoris, femur) is the largest of the tubular bones. Its upper epiphysis is represented by a rounded head, which passes into the neck, greater and lesser trochanters. The body of the bone is smooth in front and on the sides, and on the posterior surface there is a rough line consisting of two thickenings - the lateral and medial lips. The lower epiphysis of the bone is thickened and forms two condyles - a larger medial and a smaller lateral, which are separated from each other by the intercondylar fossa. The lateral sections of the condyles are rough elevations - the medial and lateral epicondyles.

The patella is the largest sesamoid bone. It is round, convex in front, and has an articular surface at the back for articulation with the femur. Located in the thickness of the tendon of the quadriceps femoris muscle. It can be easily felt through the skin and serves as an external landmark of the knee joint.

The bones of the leg are represented by two bones: the tibia, located on the inside of the leg, and the fibula, located on the outside of the leg.

The tibia (tibia) at the top is significantly thickened and forms two condyles - medial and lateral, bearing the upper articular surfaces for connection with the condyles of the femur. Below the lateral condyle there is a fibular articular surface - the place of articulation with the head of the fibula, and the tibial tuberosity protrudes in front - the place of muscle attachment. The body of the tibia is triangular, with three edges and three surfaces. The anterior ridge can be easily felt under the skin along the entire length of the bone. The lateral interosseous edge faces the same edge of the fibula and serves as the attachment point for the interosseous membrane (membrane). The lower end of the tibia has an articular surface for connection with the talus and a bony process - the medial malleolus.

The fibula is located outside the tibia and is much thinner. The upper end of the bone is thickened in the form of a head with an articular surface for articulation with the tibia, the lower end forms the lateral malleolus with an articular surface for articulation with the talus. The lateral malleolus clearly protrudes under the skin and is easily palpable.

The bones of the foot are divided into three sections: tarsus, metatarsus and toes. The tarsus includes the talus, calcaneus, navicular, three sphenoid and cuboid bones (Fig. 31).

Rice. 31. Bones of the right foot, dorsum. 1 - talus; 2 - calcaneus; 3 - cuboid bone; 4 - scaphoid bone; 5, 6, 7 - medial, intermediate and lateral sphenoid bones, respectively; 8 - I metatarsal bone; 9 - line of the tarsometatarsal joint; 10 - line of the transverse joint of the tarsus

The metatarsus is made up of five tubular bones that have heads for articulation with the main phalanges of the fingers.

The toes consist of three phalanges: proximal, middle and distal, with the exception of the big toe, which has two phalanges.

The connection of the bones of the free lower limb is carried out using joints and ligaments. There are hip, knee, ankle and foot joints.

The hip joint (articulatio coxae) is cup-shaped1. Formed by the head of the femur and the acetabulum of the pelvic bone, the depth of which is increased due to the cartilaginous acetabulum located along its edge. Inside the joint is the round ligament of the head of the femur, which carries blood vessels and nerves to the head.

1(Movements in the joint are possible around three main axes: frontal - flexion and extension, sagittal - abduction and adduction, vertical - outward and inward rotation (supination and pronation). Circular movements are also possible. The scope of these movements is limited.

)

The joint capsule is strong and reinforced by ligaments. The strongest of the ligaments is the anterior iliofemoral ligament, which can withstand loads of up to 300 kg. With its tension, it prevents hip extension.

The knee joint (articulatio genus) is the largest and most complex joint; in shape it belongs to the condylar joint (Fig. 32). It articulates the articular surfaces of three bones: the condyles of the femur and tibia and the patella. The main movement - flexion and extension - occurs around the frontal axis. The joint capsule is strengthened by strong lateral ligaments. Inside the joint there are cartilage pads - the lateral and medial menisci, as well as the anterior and posterior cruciate ligaments. The synovial membrane of the articular capsule forms inversions and folds. When the knee is bent, the lateral ligaments relax, and the spherical posterior sections of the femoral condyles appear on the articular surface of the tibia. In this position, slight rotation of the lower leg outward and inward around the vertical axis is possible.

Rice. 32. Knee joint; right. The joint capsule is removed, the hip is flexed (front view). 1 - surface for articulation with the patella; 2, 17 — condyles of the femur; 3, 14 — menisci; 4, 12 - collateral (lateral) ligaments that strengthen the joint capsule; 5 - patella; 6 - fibula; 7 - tibia; 8 - interosseous membrane; 9 - tendon of the quadriceps femoris muscle; 10 - ligament between the head of the fibula and the tibia; 11 - patellar ligament; 13 - transverse ligament of the knee; 15, 16 - cruciate ligaments

Synovial bursae lie around the joint; some of them communicate with the cavity of the knee joint.

Connection of the lower leg bones to each other: the upper ends of the tibia and fibula form a flat, inactive joint; the bodies of these bones are connected by an interosseous membrane, and the lower ends by ligaments.

The ankle joint (articulatio talocruralis) provides the connection between the foot and the lower leg. It is block-shaped in shape, formed by the lower ends of the tibia and fibula, the ankles of which, in the form of a fork, cover the talus. The joint capsule is strengthened by lateral ligaments. The joint is capable of plantar flexion and extension (or dorsiflexion) around a frontal axis passing through the trochlea of ​​the talus. In addition, slight lateral movements are possible with plantar flexion.

The tarsal bones are connected by joints, the bags of which are strengthened by short ligaments on both the plantar and dorsum of the foot. The movements in these joints complement the movements in the overlying ankle joint, thereby achieving greater freedom of movement of the entire foot. In surgery, the talonavicular and calcaneocuboid are joined into one transverse tarsal joint (Chopard's joint). The foot is amputated along the line of this joint, having previously cut the interosseous ligament, which diverges like two bundles from the calcaneus to the navicular and cuboid bones. This ligament is called the key of the Chopart joint.

The tarsal bones are connected to the bases of the metatarsal bones by flat, inactive tarsometatarsal joints. Their joint capsules are strengthened by dorsal, plantar and interosseous ligaments. In surgery, these joints are known as the Lisfranc joint. To isolate the distal part of the foot in this joint, it is necessary to cross one of the strongest interosseous ligaments - the medial tarsometatarsal interosseous ligament. It is the key to the Lisfranc joint.

The metatarsophalangeal and interphalangeal joints in their structure and movements correspond to similar joints of the hand.

The foot as a whole performs a supporting function when standing and walking. The bones of the foot, connecting with each other, form an elastic arch, convex upward. This structure is due to the vertical position of the human body, increasing the load on the foot when walking upright.

The foot rests on the calcaneal tubercle in the back and on the heads of the metatarsal bones in front. There are five longitudinal arches corresponding to the five bone rays of the foot and one transverse arch. The longest and highest is the I longitudinal arch. The inner surface of the II arch at the medial edge of the foot has the greatest concavity.

In addition to ligaments, muscles and fascia take part in strengthening the arches of the foot. When the ligaments and muscles relax, the arch of the foot drops. This can lead to disruption of the correct structure of the foot and the formation of flat feet.

Interestingly, in most people, due to muscle fatigue in the evening, the foot becomes somewhat flattened and lengthened.

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