Femoral head anatomy. Large and small trochanter of the femur

Date: 03.03.2020

The longest and most massive in the human body is the femur. She is directly involved in the implementation of movements when walking, running. Any injury or deviation from the normal structure will inevitably affect its functions.

In the anatomical atlas, the human skeleton contains two such bones, located to the right and left of the spine. In its natural position, the femur is at an angle to the vertical.

Anatomy describes the following elements with different structures:

diaphysis - the middle part of the body of the bone, containing the medullary cavity;
proximal and distal epiphyses (upper and lower, respectively), with well-defined condyles - thickening of the pineal gland;
two apophysis - protrusions, each of which has its own core of ossification in the process of osteosynthesis;
metaphyses - areas located between the diaphysis and the pineal gland, providing lengthening of the femur in childhood and adolescence.

The relatively complex structure is due to the purpose of the human femur and the peculiarities of the attachment of the leg muscles. The proximal pineal gland ends with a head, and near its apex there is a small rough depression to which the ligament is attached. The articular surface of the head is connected to the acetabulum of the pelvis.

The head crowns the neck, which makes an angle of about 114-153 ° to the longitudinal axis of the diaphysis (the smaller the angle, the wider the pelvis). The apex of the improvised corner from its outer side is headed by a large trochanter - a prominent tubercle of the femur with a fossa on the inner surface. The intertrochanteric line on one side and the intertrochanteric crest on the other, connect the lesser and greater trochanters of the femur. The designated formations serve for the attachment of the muscles.

The body of the bone is close to a cylindrical shape, triangular in cross-section, slightly twists around the axis and bends forward. The surface of the body is smooth, but the posterior part contains a rough line (the place of muscle attachment), which diverges into 2 lips near the epiphyses. Near the lower, lateral and medial lips are separated, forming the popliteal surface. Approaching the greater trochanter, the lateral lip gradually transforms into the gluteal tuberosity, to which the gluteus maximus muscle is attached. The medial lip near the superior epiphysis extends towards the lesser trochanter.

The distal epiphysis expands downward, two rounded condyles are formed on it, somewhat protruding in the posterior direction. In front, between the condyles, there is a saddle-shaped deflection, to which the patella is attached when the knee joint is extended. The rear view allows you to distinguish the intercondylar fossa.

Development

X-ray studies are one of the methods for studying the anatomy of the skeleton. Osteogenesis of the femur is a long process that ends by the age of 16-20. The primary point is formed in the diaphysis at the 2nd month of embryo development. Secondary points - at different times.

So, one of them in the distal pineal gland arises in the final weeks of intrauterine development. Between the first and second years of a child's life, a point of ossification of the upper pineal gland appears. The greater trochanter begins ossification at the age of 3 years, the small trochanter at the age of 8. Fracture resistance, which is responsible for the quality of bone tissue, is established at a young age.

Fractures

Bones become more fragile with age. While it is easier for most young people to avoid serious injury, then the elderly should take care of themselves: the most common fall or sudden rise on one leg in an attempt to maintain balance can lead to a fractured hip. Osteoporosis, characterized by decreased bone density, weakened muscle tone, and partial loss of control of the body by the brain are additional factors that increase the risk of fractures.

Older women are more likely to receive injuries of this kind, which is explained by the structure of the female femur: a smaller angle between the neck and diaphysis, a thinner neck, in comparison with the male. Osteoporosis in women is also more pronounced, and this aggravates the situation. A middle-aged or young person may be injured by a violent blow, fall from a height, or a car accident. The development of a bone cyst, the causes of which are difficult to establish today, inevitably weakens the bone section.

Symptoms of this phenomenon:

the hip joint hurts a lot when trying to move your leg;
the victim is unable to lift the limb off the floor;
the foot is turned outward.

In some cases, a person may experience a painful shock, and with an open fracture, significant blood loss.

Depending on the location of the injury, an intra-articular fracture is distinguished (the neck or head of the femur is affected), intertrochanteric and diaphyseal. Pain in these areas, in conjunction with other symptoms characteristic of each case, may also indicate the presence of:

diseases of bones and joints (osteoporosis, arthrosis, etc.);
neurological disorders;
allergic diseases, gout, tuberculosis.

Fracture diagnosis

Visual assessment will immediately reveal a violation of the integrity of the femur body. Deformity of the hip is obvious if the victim is not lucky enough to confine himself to a crack. An open fracture, accompanied by a rupture of soft tissues, establishes an unambiguous prohibition for the patient to any attempt to move the leg.

In cases where the greater trochanter is injured, swelling is found in the superior epiphysis of the femur. The main way to identify the clinical picture is research using an X-ray machine. In addition to determining the type and severity of the fracture, such a study will determine the presence of a crack that is not diagnosed by external examination, and also reveal how much soft tissue has suffered.

Fracture treatment

The tactics of the prescribed treatment depends on the type of injury.

The crack requires the imposition of a plaster cast, complete exclusion of physical activity and strict adherence to bed rest. The duration of treatment is regulated by the attending physician;
A fracture in which the head or neck of the femur is affected without displacement is treated with a plaster cast and a pelvic girdle or Beller splint to maximize limitation of limb mobility;
A damping splint is also prescribed for displaced fractures. The shape of the bone is restored, a wire is inserted into the limb. If attempts to join the fragments were unsuccessful, surgical intervention is necessary;
Treatment of an open fracture differs from a closed fracture by measures to prevent an infectious lesion. Small fragments are eliminated, the rest are put together.

Important! Beller's splint is a device designed for skeletal traction and connection of bone fragments with associated damping (damping of vibrations) to ensure the immobility of the limb. The design of the tire is a frame device weighed down with a load on which the leg rests.

Healing lasts at least a month. In the course of treatment, periodic, with an interval of about 7 days, X-ray control of the fracture is carried out.

Possible complications during treatment

For various reasons, whether it is a genetic predisposition, a medical error or the inability to carry out high-quality treatment, abnormalities of bone fusion from the norm may develop. The patient can be diagnosed with a disability of the II or III group.

Incorrect fusion of the debris can lead to pathology: a false joint or pseudoarthrosis of the femur is formed. This condition is characterized by abnormal mobility in the area of pathology, changes in muscle strength, visible and felt shortening of the leg. In this case, the treatment takes a significant amount of time. Pathology is corrected surgically;
Aseptic necrosis (pathology of blood flow in the artery of the femoral head) is a possible complication of unsuccessful treatment of the femoral neck. It is characterized by pain in the hip joint, which can be projected onto the front surface of the thigh, into the groin area, and into the gluteus muscle. If the pain does not subside when taking anti-inflammatory drugs or analgesics, then hip replacement is prescribed.

In order to prevent possible complications, such as pseudarthrosis and necrosis, or their timely elimination, it is important to monitor the condition of the injured limb, and immediately take the necessary measures.

The femur or os femoris in Latin is the main element of the human locomotor system. It is distinguished by its large size and elongated, slightly twisted shape. A rough line runs along the back contour connecting the hard tissue with the muscles. Due to its structural features, the bone element distributes body weight during movement, and also protects the joints under increased stress.

Human femur anatomy

The shape of the thigh bone is elongated, cylindrical, which is why it was called tubular. The body of the link bends smoothly in the upper part and expands in the lower part.

Above, the solid body articulates with the hip joint, below - with the patella and tibia. An educational film - the periosteum - is attached to the front side of the tubular matter. Thanks to the shell, the growth and development of bone tissue occurs, as well as the restoration of the structure after damage and trauma.

The large femur increases smoothly as the baby develops in the womb and completes growth by the age of 25. After which the element ossifies and takes on its final shape.

The lower limb, together with the vascular system, muscles, nerve nodes, connective tissues, forms the thigh. Above and in front, the limb is limited by the inguinal ligament, and behind by the gluteal fold. The lower contour extends 5 cm above the patella. The right and left bones are identical in design.

Features of the structure and structure

Tubular matter is attached to other parts of the skeleton through joints and ligaments. Muscles adjoin the connective tissues, nerves and blood vessels are located parallel to the bone. The area of articulation of the tendons and the solid body has a tuberous surface, the place of attachment of the arteries is characterized by the presence of grooves.

Like the rest of the tubular elements, the femur is divided into three main segments:

proximal pineal gland - upper sector;
distal pineal gland - lower part;
the diaphysis is the central axis of the body.

If we consider the structure of the human femur in detail, smaller elements are also visible. Each particle has its own function in the formation of the locomotor apparatus.

Proximal pineal gland

The upper part of the tubular matter is called the proximal pineal gland. The edge has a spherical, articular surface adjacent to the acetabulum.

There is a fossa in the middle of the head. The end and central part of the bone element is connected by the neck. The base is crossed by two tubercles: the lesser and greater trochanter. The first is located inside, on the back of the bone, and the second is felt through the subcutaneous tissue.

Moving away from the greater trochanter, the trochanteric fossa is located in the neck area. In front, the parts are connected by an intertrochanteric line, and on the reverse side - by a pronounced ridge.

Diaphysis

The body of the tubular element has a smooth surface on the outside. A rough line runs along the back of the thighbone. The strip is divided into two parts: lateral and medial.

The lateral lip at the top develops into a tubercle, and the medial lip grows into a comb stripe. On the reverse side, the elements diverge at the distal end, forming the popliteal region.

A canal with bone marrow is laid through the diaphysis, where blood cells are formed. In the future, mature erythrocytes are replaced by adipose tissue.

Distal pineal gland

The lower part of the bony body gradually expands and flows into two condyles: lateral and medial. A joint runs along the edge that connects the knee pad and the tibia. The end part is divided by the intercondylar fossa.

On the side of the articular surface, there are notches called the lateral and medial epicondyles. Ligaments are attached to these areas. Above the medial epicondyle, the adductor tubercle passes, to which the medial muscles adjoin. The relief is well felt under the skin from the inside and outside.

Pits and bumps in the tubular bone create a porous structure. Muscle fibers, soft tissues and blood vessels are attached to the surface.

The femur as the basis of the musculoskeletal system

Solid elements of the skeleton and muscles are involved in the formation of the system. The femur and ligaments form the basis for the human skeleton and internal organs.

The role of thigh muscle tissue

Muscle fibers, which are attached to the links of the skeleton, are responsible for the movement of the body. By contracting, the tissues set the human skeleton in motion. Responsible for the activity of the corps:

Muscles of the anterior group:

four-headed - participates in flexion of the hip at the hip joint and extension of the lower leg at the knee;
tailor - turns the lower limbs.

Muscles of the back of the thigh:

popliteal - is responsible for the activation of the knee joint and rotation of the bootleg;
a group of biceps, semi-membranous and semi-tendinous tissue - flexes and unbends the joints of the thigh and lower leg.

Medial muscle fibers:

thin;
comb;
adductor muscles.

The group sets the hip in motion, performs rotation, flexion of the lower leg and knee joint.

Femur functions

The femur is the connecting link between the lower limbs and the trunk. The element is distinguished not only by its large size, but also by its wide functionality:

Strong support for the body. With the help of muscle fibers and connective tissues, it ensures the stability of the body on the surface.
Lever that sets in motion. Ligaments and a tubular element bring the lower limbs into action: movement, rotation, braking.
Growth and development. Skeleton formation occurs over the years and depends on the correct growth of bone tissue.
Participation in hematopoiesis. This is where the maturation of stem cells to erythrocytes takes place.
Role in metabolic processes. The structure accumulates useful substances that carry out the mineralization of the body.

Muscle contraction and strength depends on how much calcium the bone tissue will form. The mineral is also necessary for the formation of hormones, the proper functioning of the nervous and heart systems. With a calcium deficiency in the body, a reserve supply of a trace element from bone tissue comes to the rescue. Thus, the optimal balance of the mineral is constantly maintained.

The lower part of the human skeleton is responsible for the mobility of the body and the correct distribution of the load. Injuries and violations of the integrity of the tissues of the thigh lead to dysfunctions of the musculoskeletal system.

Bone damage

The femur tubular bone can withstand heavy loads, however, despite its strength, the structure is capable of breaking or cracking. This is explained by the fact that the element is very long. Bone tissue cannot withstand a fall on a solid object or a directed impact. Elderly people are especially prone to fractures, as skeletal elements become more fragile with age.

The thigh bone is 45 cm long. This is a quarter of the height of an adult. Damage disrupts physical activity and limits body functions.

Factors that increase the likelihood of a fracture:

osteoporosis - a decrease in the density of hard tissue;
arthrosis - damage to bone and articular areas;
muscle hypotonia - weakening of fiber tension;
violation of control over the body - the brain does not give signals;
a bone cyst is a benign tumor-like formation.

Women of mature age are more likely to experience trauma. This is due to the peculiarity of the structure of the skeleton. Unlike the male femur, the female femur has a slender neck. In addition, women are more likely to suffer from the listed diseases.

Damage diagnostics

If the integrity of the bone tissue is violated, a person feels severe pain, weakness and difficulty in movement. Syndromes are exacerbated by open fractures, if the broken edge has damaged the muscles and skin layers. Severe trauma is accompanied by blood loss and painful shock. In some cases, an unsuccessful fall is fatal.

Classification of bone fractures depending on the location of damage:

deformation of the upper section;
trauma in the diaphysis of the femoral element;
violation of the distal or proximal metaepiphysis.

The diagnosis of the case and the severity is carried out using an X-ray machine. The bone neck is most susceptible to fracture. Such damage is called intra-articular damage. Periarticular disorder in the lateral region is also common.

Considering the tubular bones in the human body, the femur can be called the largest of them. Since all bone tissues with a tubular structure are involved in the work of the motor apparatus, the femoral element of the skeletal column is a lever of human motor activity.

In the combined work with muscles, ligaments, the vascular system, nerve fibers and other tissues, the formed structural unit - the thigh - has a rather complex structure. Having thoroughly studied it, you can identify the causes of joint and bone pain.

Bone anatomy

The femur is the largest tubular bone tissue in the human skeleton.

She, like other tubular bones, has a body and two ends. The upper proximal section ends with a head, which serves as a connecting link to the pelvic bone.

At the junction of the neck into the bony body, there are two massive tubercles called apophyses or trochanters. The greater trochanter of the femur ends the bony body. There is a depression on its medial surface. At the lower edge of the neck there is a small trochanter located medially behind. The greater trochanter is connected to the lesser trochanter, which runs obliquely along the posterior side of the bone with the intertrochanteric crest. They are also connected on the front surface with an intertrochanteric line.

Considering in detail the anatomical structure of the femur, its anterior curvature is visualized, which has a triangular-rounded or cylindrical shape. The posterior part of the bony body consists of the lateral and medial lips, which are defined by a rough line of muscle attachment. These lips also show traces of the attachment of the thigh muscle tissue. It is noticeably closer to the center of the bony body. In the lower part of the bone, the lips diverge in different directions, forming a smooth triangular area.

The distal pineal gland expands, forming two large rounded condyles. The condyles differ in size and degree of curvature of the articular surfaces. The medial condyle stands out more inferiorly than the lateral one, although both are at the same level. This is due to the fact that in a calm natural position, the bone fragment is located at an angle, its lower end is close to the midline, and the upper one is slightly deflected. On the lower and posterior sides of the bone, both condyles are separated by a deep intercondylar fossa. On the lateral part of each condyle there is a rough tubercle located above the surface of the joint.

Video

Femur

Where is the bone and its structure

The lower limb contains the musculo-ligamentous apparatus, the vascular system, nerve fibers, and other tissues. This skeletal element forms the thigh. The upper front part of the thigh ends with the inguinal ligament, the back with the gluteal fold, the lower part of the thigh is limited by a distance of about 5 cm from the patella. The femur has different outlines: from above it is connected to the hip joint, from below it forms the knee joint, articulating with the common tibia and patella.

The outer part of the femur is the connective tissue (periosteum). It is necessary for normal development, growth of bone tissue in children, restoration of functional features of the bone after severe injuries of the femur. Since it has a tubular structure, it contains multiple items.

Femur structure:

upper and lower epiphyses (limbs);
the diaphysis of the femur (body);
bone areas located between the pineal glands and the diaphysis (metaphyses);
the junction of muscle fibers (apophysis).

At the base of the upper epiphysis, the head is located, together with the pelvis, participating in the formation of the joint. In the acetabulum, with the help of cartilaginous tissue, the three bones - the pubic, ischial and iliac bones - are articulated.This characteristic feature of the organism manifests itself until the age of 15 years. Over the years, these bone tissues are connected to each other, forming a strong frame.

The joint of the hip apparatus combines all the bones into a single whole. On the surface of the condyles there is cartilaginous tissue, inside there is a loose connective tissue. If the joint space is displaced, this may indicate pathological changes in the cartilage tissue. Most often, this indicates the development of arthrosis, since at this stage, limitation of motor activity is not yet observed.

Femoral head

The superior proximal epiphysis is represented by the femoral head, which is connected with the rest of the bone tissue with the help of the neck. The surface of the head is directed upwards, located closer to the median longitudinal plane of the muscular structures.

The femoral fossa is located in the middle of the head. This is where her ligaments are located. With the help of the neck, the head is connected to the body of the femoral bone tissue, forming an obtuse angle ranging from 113 to 153 degrees. The anatomy of the femur of the female body is such that the angle depends on the width (with a large width, it is close to a straight line).

Muscle

Functional role

Being the largest bone in the skeleton, the human femur is characterized by high functional ability. In addition to being a connecting link between the trunk and lower limbs, other functional features are:

reliable support of the skeleton (due to the fastening of the main muscles and ligaments, it ensures the stability of the lower limbs on the surface);
motor (used as the main lever for movement, turns, braking);
hematopoietic (in bone tissue, stem cells mature to blood cells);
participation in metabolic processes that contribute to the mineralization of the body.

The latter function is quite important for the body. The contractile work of the muscular system depends on the presence of calcium in the composition of the bone tissue. It is necessary for both the heart muscle and the nervous system, the production of hormones. If the body contains an insufficient amount of calcium, the reserve supply of calcium in the bone tissue comes into play. This ensures the mineralization of the body, the restoration of the necessary balance.

Possible causes of pain

During a serious injury, a violation of the integrity of the bone occurs, that is, a fracture. Such injuries, resulting from a fall on a hard object, a strong blow, are accompanied by severe painful sensations, a large loss of blood. Depending on the focus of mechanical action, there are:

injuries to the upper part of the bone tissue;
violation of the integrity of the femoral diaphysis;
damage to the distal, proximal metaepiphysis.

Femoral injuries of the most powerful nature, in addition to delivering severe pain and blood loss, can be accompanied by painful shock, which can lead to death.

Trochanteritis is an inflammatory process of the hip joint, in which the trochanter is affected (the upper point of the thigh, in which almost all the hip muscles and tendons are connected and fixed).

Often, trochanteritis of the hip joint is confused with coxarthrosis (arthrosis of the hip joint), since the symptoms of these two pathologies are very similar. However, with a more detailed examination, the initially diagnosed coxarthrosis is changed to trochanteritis, respectively, adjusting the treatment with medication or folk remedies.

Features of the disease

Trochanteritis of the hip joint extends to the following elements of the thigh:

Trochanter or greater trochanter, the upper junction point of muscle and articular tissues;
Femoral tendons and soft tissues adjacent to the trochanter.

Inflammation of the femoral tendons can be infectious or non-infectious. More often one, less often two hip joints at once are affected.

The trochanter is where the numerous tendons and muscles of the buttocks and thighs are attached to the base of the thighbone. Above this element, under the skin, there is a small synovial bag, which provides smooth and non-traumatic joint mobility - a bursa.

Very often, inflammation of the trochanter also captures the bursa; inflammation of this part of the hip joint is called hip bursitis in medicine. Therefore, another name for trochanteritis is sometimes used - trochanteric bursitis.

Important information: this pathology develops mainly in women of mature age.

Medicine explains this by the anatomical features of the structure of ligaments and tendons - in men they are denser and stronger, therefore they are injured much less often.

Classification of trochanteritis by causes of occurrence

The cause of the inflammatory process in women is most often age-related changes associated with hormonal surges (menopause). With a lack of estrogen hormones, the elasticity of the ligaments decreases, the level of their tension decreases, and osteoporosis develops.

Sometimes trochanteritis is diagnosed in young patients - in this case, prolonged exposure to provoking factors becomes the cause. Depending on these factors, which caused its development, a classification of the disease has been developed:

Aseptic, or non-infectious trochanteritis, the reasons for the formation of which are in the constant overload of the joint. The most common type of disease.
Septic, or infectious trochanteritis - the cause in this case is the introduction of bacteria into the soft tissues of the joint. The infection can be brought in with blood from foci of other chronic or acute diseases in the body. Two pathologies should be treated simultaneously.
Tuberculous. A very rare type of the disease, which occurs mainly in children. The cause becomes a tubercle bacillus, and not only the greater trochanter of the thigh is affected, but also the rest of its parts. Osteomyelitis develops.

Treatment of trochanteritis of the hip joint combined with osteomyelitis is complex and lengthy.

The main symptoms of the disease

Symptoms of trochanteritis are typical for any joint disease, the main one being pain. Patients complain to the doctor about increased pain in the upper thigh during physical activity and exertion, they are absent at rest. When pressing on the trochanter area, pain is also noted.

Other symptoms of the disease:

Swelling of the joint.
Sometimes an increase in body temperature.
Redness of the skin.

These sim volumes most often tell the doctor that a septic or tuberculous form of the disease is developing.

Important: the mobility of the joint, including passive, is not limited with trochanteritis, and this is the main difference from arthrosis of the hip joint.

When examining a patient, the doctor easily identifies him, makes the correct diagnosis and selects an adequate therapy.

Diagnosis of the disease

There are no specific methods for diagnosing this disease, clinical symptoms are considered, on the basis of which the doctor confirms or refutes the presumptive diagnosis.

Additional examinations and examination of the patient are carried out solely with the aim of excluding other pathologies. These include:

Clinical and biochemical analysis of blood and urine;
Samples for rheumatoid factor;
X-ray of the hip joint;
Ultrasound of the hip joint in adults.

If it is difficult to determine the degree of tissue damage and make a diagnosis based on all these studies, MRI and computed tomography are performed.

Treatment of trochanteritis with different methods

The treatment program is drawn up depending on the cause of the disease. If symptoms of septic or tuberculous trochanteritis are obvious, and a more detailed examination confirms the diagnosis, antibiotic therapy is prescribed, and in case of tuberculosis, treatment specific to this disease is prescribed.

In case of complications in the form of suppurations and abscesses, surgical intervention is often necessary. The abscesses are opened under local or general anesthesia, cleaned and disinfected.

With the aseptic form of the disease, the following techniques and procedures are used:

Adjustment of daily routine and lifestyle. It is necessary to minimize the stress on the damaged joint. For this, for the period of the acute stage, bed rest and complete functional rest for the diseased limb are prescribed.
Drug therapy. A proven remedy that is effective for inflammation and pain, very rarely not taken by the patient's body is non-steroidal anti-inflammatory ointments and drugs. These are diclofenac, ibuprofen, indomethacin, meloxicam, which can be taken orally in the form of tablets, or administered intramuscularly through injections. The course of treatment usually lasts no more than 10 days - this is enough to eliminate all symptoms of inflammation.
Physiotherapy. Gymnastics, massage, warming up, paraffin applications, magnetotherapy, laser and shock wave therapy - all these procedures, alone or in combination with medications, have a very good effect. They not only reduce pain, but also stimulate blood circulation and tissue repair.
Therapy with folk remedies. As an auxiliary, this method of treatment is also widely used for trochanteritis of various forms. Treatment with folk remedies can be carried out at home, they are especially valuable if small children, pregnant and lactating women or the elderly suffer, for whom most of the medicines are contraindicated.

Excellent feedback from patients, along with affordable and effective folk remedies, received such a method of treatment as post-isometric relaxation. It consists in passively stretching certain groups of ligaments and muscles by giving the patient's body different positions.

This technique was created specifically for the treatment and prevention of pathologies of the musculoskeletal system. To obtain the desired result, the contact and interaction of the patient with the doctor is important. This method can also be attributed to the treatment of folk remedies and alternative medicine.

In 90% of cases of treatment with this method, a positive effect is observed after 2-3 sessions. In total, they will need from 10 to 15, depending on the stage of the disease, the cause that caused it, the age and physical development of the patient. One session lasts no more than 20 minutes, they need to be carried out every other day.

The femur is characterized by considerable size and high strength. But, in spite of this, very often all sorts of injuries provoke the loss of its integrity. A transtrochanteric fracture of the femur is damage to that part of the bone that is adjacent to the neck with one side, and the other to the pretrochanteric region of the thigh.

Approximately 20% of all victims admitted to hospitals are those diagnosed with pertrochanteric fractures of the femur. Most often they occur as a result of a strong blow, twisting of a limb, or falling to one side. Statistics show that women are injured in this way at a later age than men. A closed pertrochanteric fracture of the left femur, as well as the right one, heals much more easily than, for example, an injured femoral neck. But, despite this, this damage to the joint and its treatment is quite dangerous, especially for elderly people.

What are the types of pertrochanteric fracture?

Evans' classification table divides all pertrochanteric fractures into two groups - stable and unstable.

It is much easier to heal a stable type of joint fractures, since the violation of the cortical layer of the thigh is insignificant and it is quite simple to return it to its original position. In this case, rehabilitation after injury is relatively easy.

In the case of unstable joint damage, there is a large-scale destruction of the cortical layer. Therefore, in order to restore the bone and carry out the appropriate treatment (osteosynthesis), it is necessary to make a lot of effort and spend a significant amount of time.

The location of the trochanter is the medial surface of the hip joint. This is the reason for the formation of swelling and pronounced edema in trauma. The ossuary, which is a kind of covering of the bone area, consists of a large number of blood vessels. Timely joint treatment (for example, osteosynthesis) and proper rehabilitation prevents the occurrence of serious complications. But in most cases, the nature of the fracture affects the outcome of the situation. There are these types of damage to the femur:

Fracture with displacement (comminuted). This is a fairly common type of injury, in which lateral movement is significantly limited, and the base of the neck is deeply located in the spongy structure of the main trochanter. This provokes a significant shortening of the right leg.

Fracture with displacement (comminuted), but without an embedded femoral neck. The clinical picture is similar to the first type. But sometimes there are very scattered fragments of bones. In this regard, in order to correctly carry out the treatment (osteosynthesis), the help of highly qualified specialists with a certain skill is needed.

Transtrochanteric diaphysis lesions that extend to the trochanter, bony diaphysis and even the middle of the thigh - lateral rotation and soreness have no pronounced signs.

Treatment of each of these types requires an individual approach and the use of an appropriate rehabilitation method.

Causes

The femoral bone element is characterized not only by considerable size, but also by a fairly high density. This bone performs a very important function - it provides human motor activity. Therefore, it must be strong enough. But over the years, due to certain changes, the body begins to gradually lose calcium. As a result, the level of fragility and fragility of bones increases.

The most common cause of injury to the right femur is falling onto the greater trochanter. In some cases, this is caused by twisting. In addition, insufficient calcium or bone damage significantly increases the risk of fracture. And if there are several such factors, even a slight stress can provoke their damage.

Symptoms

A comminuted pertrochanteric fracture of the right femur provokes a deterioration in the patient's general health. This is caused by massive tissue damage and high blood loss, especially during open fractures. There are such signs of the disease:

the formation of severe swelling of the anterior surface;
the appearance of the symptom of a stuck heel;
rotation of the right limb outward;
strong pain that accompanies any action.

Diagnostics

Diagnosis consists of an external examination and palpation of the right femoral region of the leg. An important point that is present in determining the type of damage is the absence of a negative impact on the leg. In other words, it is necessary to assess how much the position of the right bone has shifted relative to its initial position.

If this norm is not observed, there is a high probability that the fragments will penetrate even further into the bone cavity and cause additional injuries. In this case, an ordinary pertrochanteric hip fracture can cause disability.

It is possible to finally establish the diagnosis and prescribe treatment (osteosynthesis) only after analyzing the results of an X-ray examination. If there is a punctured fracture of the right femur with displacement, there may be a need for computed tomography, because fragments that have settled far enough may not be shown on the roentgenogram.

Treatment methods

There are two methods of treatment for a transtrochanteric fracture:

conservative, which provides for the patient's stay in the hospital for a sufficiently long time;
operational, providing a quick recovery (osteosynthesis).

Each of these methods has its own contraindications. For example, conservative treatment is used in most cases for the treatment of inclined fractures, which are accompanied by unexpressed pain syndrome. Operation (including osteosynthesis) is most often associated with the age of the victim. Because elderly people cannot be immobilized for a long time - this can lead to exacerbation of various chronic diseases in them. In addition, as a result of this, pneumonia often occurs, bedsores are formed.

Conservative therapy

The essence of conservative or non-surgical therapy for a pertrochanteric fracture consists of stretching the diseased right limb and immobilizing the thigh with a plaster cast.

The duration of the conservative method of treatment, in contrast to the operation, is more than 5 months. And the elderly are on treatment even longer. During the first 1-1.5 months, skeletal traction is used for therapy, and then - limb immobilization using a plaster cast.

Treatment of aged people has a slightly different scheme. For the first 8 weeks, skeletal traction followed by cuff traction using a small weight.

In some cases, the doctor decides that this procedure can be replaced by a derotation boot or Chernov's cuffs.

Full rehabilitation after a pertrochanteric fracture requires at least 6 months. During this period, the patient must use a special cane or crutch for movement.

Operative method of treatment

Operation (osteosynthesis) has its own contraindications. These include the presence of the victim:

chronic heart defects;
gout;
kidney failure;
heart failure;
diabetes mellitus;
atherosclerosis;
thrombophlebitis.

When using the surgical type of treatment, the patient is on his feet within a week after the surgery. But for 3 months he needs to refrain from heavy loads on the diseased limb.

During the operation, bone fragments of the joint are fixed with brackets, metal pins or plates - osteosynthesis is done. For the manufacture of the fixing tool, templates are used, drawn up in accordance with X-ray images. But what kind of osteosynthesis will have a result is more influenced by the quality of the bone tissue, the fidelity of the alignment of the implant model.

Complications

During conservative treatment or surgery, various complications may arise. If you have osteoporosis or other diseases, it can be very difficult for the fragments of the joint to grow together. Joint fragments and screws are displaced after surgery due to improperly formed screw channels. Insufficient compression of bone fragments, as well as collapse of the cancellous tissue in the place where the bone grows together.

To eliminate these pathologies, only repeated surgical treatment is used. Moreover, it must be accompanied by correctly implemented rehabilitation.

Tubular matter is attached to other parts of the skeleton through joints and ligaments. Muscles adjoin the connective tissues, nerves and blood vessels are located parallel to the bone.

Like the rest of the tubular elements, the femur is divided into three main segments:

proximal pineal gland - upper sector;
distal pineal gland - lower part;
the diaphysis is the central axis of the body.

If we consider the structure of the human femur in detail, smaller elements are also visible. Each particle has its own function in the formation of the locomotor apparatus.

The upper part of the tubular matter is called the proximal pineal gland. The edge has a spherical, articular surface adjacent to the acetabulum.

There is a fossa in the middle of the head. The end and central part of the bone element is connected by the neck. The base is crossed by two tubercles: the lesser and greater trochanter.

Diaphysis

The body of the tubular element has a smooth surface on the outside. A rough line runs along the back of the thighbone. The strip is divided into two parts: lateral and medial.

The lateral lip develops into a tubercle, and the medial lip grows into a comb stripe. On the reverse side, the elements diverge at the distal end, forming the popliteal region.

Distal pineal gland

Outside, the femur is covered with connective tissue - the periosteum, which promotes bone growth in children, its restoration in case of fractures, etc. It, like any other tubular bone of the body, has a basic structure diagram. The femur consists of the following elements:

Epiphyses (upper and lower parts).
Diaphysis (body).
Metaphysis (areas of bone between the pineal gland and the diaphysis).
Apophyses (muscle attachment site).

The upper end of the bone ends with a head, which, together with the pelvis, participates in the formation of the joint. The head has a rough fossa that serves as the place where the ligaments are attached.

The head is connected to the body of the bone by means of a neck, which forms an angle with respect to the shaft of the bone. Normally, in men, it should be blunt. In women, due to their fertility and physiologically wide pelvis, this angle is close to 90 degrees.

In the place where the neck attaches to the body of the femur, there are apophyses - tubercles, which are called the greater and lesser trochanters. The first is located on the lateral or outer side of the bone and can even be felt under the skin.

The distal or lower end of the bone is formed by two condyles. They are thickenings of the bone, have a rounded shape, curving back. The surfaces of the condyles serve as the articular surfaces of the knee joint, from above they are connected to a triangular-shaped platform (adjacent to the patella).

On the popliteal surface, the condyles are separated from each other by a fossa. They also differ in size (the medial one is larger), but are located in the composition of the knee joint at approximately the same level, since the femur is in an oblique position.

In the anatomical atlas, the human skeleton contains two such bones, located to the right and left of the spine. In its natural position, the femur is at an angle to the vertical.

Anatomy describes the following elements with different structures:

diaphysis - the middle part of the body of the bone, containing the medullary cavity;
proximal and distal epiphyses (upper and lower, respectively), with well-defined condyles - thickening of the pineal gland;
two apophysis - protrusions, each of which has its own core of ossification in the process of osteosynthesis;
metaphyses - areas located between the diaphysis and the pineal gland, providing lengthening of the femur in childhood and adolescence.

The head crowns the neck, which makes an angle of about 114-153 ° to the longitudinal axis of the diaphysis (the smaller the angle, the wider the pelvis). The apex of the improvised corner from its outer side is headed by a large trochanter - a prominent tubercle of the femur with a fossa on the inner surface.

The intertrochanteric line on one side and the intertrochanteric crest on the other, connect the lesser and greater trochanters of the femur. The designated formations serve for the attachment of the muscles.

Near the lower, lateral and medial lips are separated, forming the popliteal surface. Approaching the greater trochanter, the lateral lip gradually transforms into the gluteal tuberosity, to which the gluteus maximus muscle is attached.

The human skeleton consists of many components, the main of which is the femur. She is responsible for supporting the body and acts as a propulsion lever.

It is based on multiple elements that allow you to make smooth movements.

The thighbone supports a person's weight and takes an active part in motor processes. The main functions of an element of the musculoskeletal system are performed due to its unique structure.

The femur has a special structure. It is based on the body and two pineal glands, proximal and distal. The anterior femoral surface is smooth; a rough line stands out on the posterior part.

It divides the entire area into two main lips, lateral and medial. The first type captures the lateral condyle and goes to the side. The lip from the upper part passes into the gluteal tuberosity.

The second type passes through the medial region, descending to the lower part of the femur. In this place, the restriction of the popliteal region is fixed. This surface is additionally bounded on the sides by two vertical lines, medial and lateral.

The medial lip and crest line are characterized by the presence of a smooth transition. In the middle of the bone there is a special feeding hole, which has special functions.

The comb line is responsible for feeding the canal. Many vessels pass through the hole. In the superior epiphysis, there are two main trochanters, large and small.

The greater and lesser trochanters play an important role in the anatomy of the femur. From the outside, they can be felt through the skin. On the upper surface of the trochanter is characterized by the presence of a fossa.

The intertrochanteric line smoothly turns into a comb-like area. On the back of the superior epiphysis, there is a ridge that ends at the lesser trochanter.

The rest is the femoral head ligament. This area is often damaged by fractures. The neck ends with a head, on the surface there is a fossa.

The anatomy of the distal pituitary gland practically does not differ from the proximal one. It is based on the medial and lateral condyle. The first type contains an epicondyle on the inner surface, and the second - on the outer area.

Anatomy

It also performs basic support functions and carries a significant load when walking, running, lifting weights.

The shape of the hip joint is presented in the form of a ball placed in a rounded cavity.

The articular cavity is formed by the pelvic bone, it is called the acetabulum or acetabular cavity. It houses the head of the femur, which connects to the body of the femur through the neck.

In common people, the neck of the femur is called the "neck of the femur". At the base of the neck there are bony eminences - the greater and lesser trochanter, to which the muscles are attached.

The shape of the bone is elongated, cylindrical, which is why it was called tubular. The body of the link bends smoothly in the upper part and expands in the lower part.

Above, the solid body articulates with the hip joint, below - with the patella and tibia. An educational film - the periosteum - is attached to the front side of the tubular matter.

The lower limb, together with the vascular system, muscles, nerve nodes, connective tissues, forms the thigh. at and in front, the limb is limited by the inguinal ligament, and behind by the gluteal fold.

What is at the heart of the pivot element

Solid elements of the skeleton and muscles are involved in the formation of the system. The femur and ligaments form the basis for the human skeleton and internal organs.

Muscles of the anterior group:

four-headed - participates in flexion of the hip at the hip joint and extension of the lower leg at the knee;
tailor - turns the lower limbs.

Muscles of the back of the thigh:

popliteal - is responsible for the activation of the knee joint and rotation of the bootleg;
a group of biceps, semi-membranous and semi-tendinous tissue - flexes and unbends the joints of the thigh and lower leg.

Medial muscle fibers:

thin;
comb;
adductor muscles.

The group sets the hip in motion, performs rotation, flexion of the lower leg and knee joint.

The femur is the connecting link between the lower limbs and the trunk. The element is distinguished not only by its large size, but also by its wide functionality:

Strong support for the body. With the help of muscle fibers and connective tissues, it ensures the stability of the body on the surface.
Lever that sets in motion. Ligaments and a tubular element bring the lower limbs into action: movement, rotation, braking.
Growth and development. Skeleton formation occurs over the years and depends on the correct growth of bone tissue.
Participation in hematopoiesis. This is where the maturation of stem cells to erythrocytes takes place.
Role in metabolic processes. The structure accumulates useful substances that carry out the mineralization of the body.

With a calcium deficiency in the body, a reserve supply of a trace element from bone tissue comes to the rescue. Thus, the optimal balance of the mineral is constantly maintained.

The structure of the femur is quite simple. It is based on cylindrical structures that expand towards the bottom. There is a special surface behind, characterized by the presence of a rough line.

It has a tight relationship with the leg muscles. The head of the femur is located on the proximal epiphysis. It is characterized by the presence of an articular surface, the main function of which is the articulation of the bone with the acetabulum.

The fossa of the femoral head is located exactly in the middle. It is connected to the body of the main element through a neck. Its peculiarity is its location at an angle of 130 degrees.

The femoral neck is localized near two bumps called the trochanter. The first element is located near the skin, which makes it easy to feel.

This is the lateral trochanter, which is connected to the second tubercle through the intertrochanteric line. From the back, the intertrochanteric ridge is responsible for the performance of functions.

The trochanteric fossa is localized near the femoral neck. The tuberosity of the structure allows the muscle to freely attach to the bone element. The lower end of the bone is slightly wider than the upper end, while the transition is smooth.

The radius of the condyle decreases posteriorly, which gives the element a spiral shape. Its lateral surfaces are characterized by the presence of protrusions. Their function is to secure the ligaments. These elements are easily felt through the skin.

Femur anatomy

The anatomy of the femur is complex. The support element is based on components that ensure reliability during movement. The right and left bones do not have any special differences, while they are characterized by the same structure and functional features.

Elena Polyakova doctor

Femur - fracture, necrosis, head

The head of the femur rests on the superior proximal epiphysis, connecting with the rest of the bone by means of a neck that is spaced from the axis of the femur body at an angle of degree.

At the boundaries of the transition of the neck to the body of the femur there are two powerful tubercles, which are called trochanters. The location of the greater trochanter is lateral; the trochanteric fossa is located on its median surface.

The lesser trochanter is located below the neck, occupying a medial position in relation to it. In front, both trochanters - both large and small - are connected by an intertrochanteric crest.

If in doubt about the correctness of the diagnosis, an injection of an anesthetic is given inside the bag. If the pain after this procedure disappears, the diagnosis is correct.

The thigh should be bent at the hip joint to an angle of ° and slightly rotated outward. Fracture healing occurs in the fifth or sixth week.

The accumulated experience in the surgical treatment of hip fractures in affected older age groups gives grounds to assert that the introduction of artificial joints into clinical practice made it possible to apply an active functional method of treatment, free the victims from prolonged use of crutches, significantly reduce the length of stay of the victim in the hospital and prevent a fatal complication. which are the cause of high mortality.

The head of the femur rests on the superior proximal epiphysis, connecting with the rest of the bone by means of a neck spaced from the axis of the femur body at an angle of 114-153 degrees.

Possible damage

The femur tubular bone can withstand heavy loads, however, despite its strength, the structure is capable of breaking or cracking. This is explained by the fact that the element is very long.

Bone tissue cannot withstand a fall on a solid object or a directed impact. Elderly people are especially prone to fractures, as skeletal elements become more fragile with age.

Factors that increase the likelihood of a fracture:

osteoporosis - a decrease in the density of hard tissue;
arthrosis - damage to bone and articular areas;
muscle hypotonia - weakening of fiber tension;
violation of control over the body - the brain does not give signals;
a bone cyst is a benign tumor-like formation.

Women of mature age are more likely to experience trauma. This is due to the peculiarity of the structure of the skeleton. Unlike the male femur, the female femur has a slender neck. In addition, women are more likely to suffer from the listed diseases.

proximal, diaphyseal, distal. These possible variants of injury are distinguished by the mechanism of damage, so it is worth considering them separately.

Depending on the location in relation to the hip joint, fractures of the proximal bone are classified into intra- and extra-articular. The former are more dangerous, since there is a risk of damage to the artery supplying the head of the femur, which is dangerous for the development of necrosis.

Due to the fact that the bone forms an angle that is sharper in women, this injury in men occurs 2 times less often. Most often, a fracture in this place occurs in the elderly.

The main reason for the violation of integrity is a blow resulting from a fall on a slippery surface (ice, slippery floor, etc.). In this case, the leg is turned outward and somewhat shortened, and any attempts to move cause pain - these are the main signs that allow one to suspect a fracture of the upper part of the femur.

Types of diaphyseal fractures of the femur.

Fractures of the femur body are relatively rare, as it takes a lot of force to break the integrity. There are such injuries when falling from a height, car accident.

Since the force acting on the leg is high, the fracture is usually associated with soft tissue injury. In this case, the shortening of the limb can reach 8–10 cm, since the fragments of the bone are significantly retracted by the muscles attached to them.

Fractures of the lower part of the bone occur as a result of a fall to the knee or a strong impact. It is also possible an option in which there is a violent deflection of the lower leg outward or inward - then the condyles of the femur break off under the influence of the upper part of the tibia.

This happens if you fall from a height to your feet. With this injury, limb shortening does not occur. The predominant symptoms are severe pain in the knee joint, swelling, possibly deviation of the lower leg to the side.

The femur is one of the important structural elements of the skeleton, which serves as a support, a lever for movement, the formation of blood and a depot of minerals.

Knowledge of its anatomy is important not only for a traumatologist, every man in the street should have at least a superficial idea of the structure of our body. After all, this is not only useful, but also very interesting information!

Isolated fractures of the greater trochanter have a transverse oblique fracture plane and are often multi-splintered.

Briand's triangle is broken and Shemaker's line runs below the navel. On palpation, the intensity of pain increases with direct contact with the swivel itself.

It also performs basic support functions and carries a significant load when walking, running, lifting weights.

Resting, analgesics, exercise, LA / steroid injections.

Incorrect fusion of the debris can lead to pathology: a false joint or pseudoarthrosis of the femur is formed. This condition is characterized by abnormal mobility in the area of pathology, changes in muscle strength, visible and felt shortening of the leg. In this case, the treatment takes a significant amount of time. Pathology is corrected surgically;
Aseptic necrosis (pathology of blood flow in the artery of the femoral head) is a possible complication of unsuccessful treatment of the femoral neck. It is characterized by pain in the hip joint, which can be projected onto the front surface of the thigh, into the groin area, and into the gluteus muscle. If the pain does not subside when taking anti-inflammatory drugs or analgesics, then hip replacement is prescribed.

The bones of the free lower limb include the femur, bones of the lower leg, feet, sesamoid bones (patella, etc.). Despite the fact that the bones of the lower limb are homologous to the bones of the upper limb, there are significant anatomical differences between them.

The femur (femur) (Fig. 94) is a steam room, has two pineal glands and between them the diaphysis is the body (corpus femoris). The proximal end ends with a head (caput femoris), which is 2/3 covered by the articular surface.

In the center of the head there is a small fossa (fovea capitis femoris). The head continues into the neck (collum femoris), which in men is located at an angle of 127 ° to the body.

In women, the angle is slightly smaller - 112 °, which, together with a wider pelvis, creates a wider pelvic girdle than in men. In a newborn, the angle is about 150 °.

Above and below the femoral neck there are two tubercles, named for their large size trochanter major et minor; from them on the back surface of the body passes the intertrochanteric crest (crista intertrochanterica), and along the front - the intertrochanteric line (linea intertrochanterica).

On the posterior surface of the body, below the intertrochanteric crest, there is a gluteal tuberosity (tuberositas glutea), from which a rough line is directed downward, consisting of the lateral and medial lips (linea aspera).

These two lines in the lower parts of the bone diverge and limit the popliteal surface (facies poplitea), which has a triangular shape. The medial lip in the upper part of the femur continues into a comb line (linea pectinea).

The distal end of the femur is expanded by two condyles (condylus lateralis et medialis); they are separated by the intercondylar fossa (fossa intercondylaris), bounded from above by the intercondylar line (linea intercondylaris).

Both condyles have different curvatures in the sagittal direction. The medial condyle has a larger radius than the lateral one. This is due to the fact that the heads of the femurs are 12.5 cm apart from each other, and the medial condyles are almost in contact and their lower surfaces are located along one horizontal line.

The different radius of the condyles inhibits extension in the knee joint, providing smooth movement, creating conditions for wedging at full extension, which makes the joint more durable and stable.

Above the condyles are the supracondylar eminences (epicondylus lateralis et medialis). In front, the surfaces of both condyles merge into one another, forming the patellar surface (facies patellaris), where the thigh articulates with the patella.

Ossification
... At the 6th week of embryonic development, an ossification nucleus arises in the cartilaginous model of the femoral diaphysis. By the time of birth, the upper epiphysis is always cartilaginous, and in the lower epiphysis there is ossification with a diameter of 1 cm.

At the beginning of the first year of life, a nucleus arises in the head of the bone, which grows together with the neck of the femur by the age of 18-20. In addition, in the 2nd-3rd year, an independent nucleus appears in the greater skewer, and in the 8-12th year - in the lesser skewer.

Femur necrosis

Femoral necrosis is a serious disease that develops as a result of a violation of the structure, nutrition or fatty degeneration of bone tissue. The main cause of the pathological process developing in the structure of the femur is a violation of blood microcirculation, osteogenesis processes and, as a consequence, the death of bone tissue cells.

There are 4 stages of femoral necrosis:

Stage IV - the time when the femoral head is completely destroyed, which leads to the patient's disability.

The occurrence of femoral necrosis is facilitated by:

Injuries of the hip joint (especially with a fracture of the femoral head);
Household injuries and cumulative overloads, resulting from sports or physical activity;
The toxic effects of certain drugs;
Stress, alcohol abuse;
Congenital dislocation (dysplasia) of the hip;
Bone diseases such as osteoporosis, osteopenia, systemic lupus erythematosus, rheumatoid arthritis;
Inflammatory, colds, which are accompanied by endothelial dysfunction.

The method of treating femoral necrosis depends on the stage of the disease, its nature, age and individual characteristics of the patient. To date, there are no drugs that can fully restore blood circulation in the femoral head; therefore, organ restoration is most often carried out by surgical methods. These include:

Decompression of the femur - drilling several canals in the head of the femur, inside which vessels begin to form and grow;
Fibular graft transplant;
Endoprosthetics, in which a damaged joint is replaced by a mechanical structure.

Stage I is characterized by periodic pain radiating to the groin area. At this stage, the cancellous substance of the femoral head is damaged;
Stage II is characterized by severe constant pain that does not disappear at rest. Radiographically, the head of the femur is speckled with small, like eggshell cracks;
Stage III is accompanied by atrophy of the gluteal muscles and muscles of the thigh, there is a displacement of the gluteal fold, shortening of the lower limb. Structural changes account for about 30-50%, a person is prone to lameness and uses a cane for movement.
Stage IV - the time when the femoral head is completely destroyed, which leads to the patient's disability.

What is the femur bone made of?

The normal anatomy of the femur implies the following main parts:

body;
proximal pineal gland;
distal pineal gland.

It is necessary to consider these parts separately. For a better understanding of the structural features, you can watch the video.

This is a cylindrical section, which differs in some bending towards the front. Its surface is smooth in front, and a rough line runs from the back.

Its main function is to strengthen the muscles. She, in turn, is divided into lateral and medial lips. The first in the upper part passes into the gluteal tuberosity, and in the lower part it passes to the lateral condyle when tilted to the side.

The second also deviates downward, but departs to the medial condyle. In the upper part, it merges with the comb line. Together, these lips and supracondylar lines define the popliteal surface in the lower region of the femur bone.

Thigh muscles

It is the thigh muscles, together with the bone, that play a special role in providing motor movements in this area. There are three main muscle groups:

front;
medial;
back.

Each group is represented by different types of muscles that perform separate functions.

Structure, function and diseases of the hip joint

The quadriceps muscle consists of four heads, which explains its name. Each of them is a separate muscle. They perform the function of hip flexion and lower leg extension.

The tailor is the longest human muscle. With its help, it is possible to bend the thigh and lower leg. When abducting and flexing the thigh, it is clearly visible under the skin.

This includes the following muscles:

Leading long: similar to a triangle in its shape, provides hip drive.
Leading short: participates in the drive and partially in the flexion of the thigh.
Leading large: connected to the medial epicondyle and a rough line. She is given the main role in the drive.
Comb: participates in flexion, adduction and supination of the hip.
Thin: Adducts the hip and assists in flexion of the lower leg.

This group consists mainly of muscles involved in the hip drive. They play a special role in its proper functioning.

Muscles of the posterior group

These include the following muscles:

Double-headed: it can be felt in the area of the fossa under the knee. She participates in flexion and supination of the lower leg, and also extends the thigh.
Semitendinosus: performs the same functions and has a common origin with the biceps muscle.
Semi-membranous: helps to unbend the thigh, takes part in flexion and pronation of the lower leg.

You can see the location of the thigh muscles in the photo.

Congenital anomalies

The main anomalies of the human femur include the following congenital pathologies:

underdevelopment;
dislocation of the hip and joint dysplasia;
valgus and varus deformities.

These conditions, left unattended in childhood, can lead to serious consequences in the future. Some of them can make a child disabled for life.

Bone underdevelopment

This deviation is more than 1% of the number of congenital skeletal deformities. Often this condition is combined with other pathologies, including the absence of the patella. The main symptom of underdevelopment is lameness.

Incomplete development of the large femur has the following features:

In cases of diaphysis pathology, the joints retain their function.
In case of violations of the distal parts, the pelvis descends towards the lesion.
The thigh and gluteal muscles atrophy.
The gluteal fold is not observed or is smoothed.
Pathology is easily detected by X-ray examination.

In this case, surgical treatment is necessary in order to restore the length of the leg, which depends on the age of the patient and the severity of the pathology. The following methods can be used:

Surgical intervention aimed at stimulating the growth zones. It is performed at an early age.
Osteotomy with a distraction device. This method is used for patients aged 4-5 years.
Amputation of the foot. It is used if the shortening is too strong, and therefore the restoration of the length is impossible. In some cases, the operation is combined with arthrodesis of the knee joint.
Orthopedic aids and footwear. They can help with a slight underdevelopment of the child's bone in the early stages.

The earlier such a pathology is detected, the easier it will be to eliminate it. The methods of treatment in each case are determined by the doctor.

Dislocation of this type is diagnosed in very rare cases, while unilateral dysplasia of the hip joint is quite common. It is expressed by lameness and shortening of the leg.

If the disease is diagnosed at an early age, conservative therapy is carried out using special splints, pillows and other devices that correct the articular structure.

Such pathologies are the result of cervical ossification. Cartilage damage in the womb is also often the cause. In almost 30% of cases, the deformity is bilateral.

How is the femoral head supported by the annular fossa?

Hallux valgus is rarely diagnosed, as it proceeds without symptoms. Whereas varus significantly limits the movement of the leg and leads to lameness. Its manifestations are similar to a dislocated hip.

X-ray examination shows thinning and shortening of the bone, as well as violations of ossification of the femoral head. Treatment is carried out with surgery and corrective osteotomy.

Functional role

The femur is the largest skeletal element. In this regard, it is not just the most important structural link connecting the trunk and lower limbs, but also performs a number of other vital functions. Basic:

Calcium plays an important role in the structure of bones and teeth.

Support - it is the place of attachment of the main muscles and ligaments that ensure the movement of the human body.
Movement - the bone is used as a lever to move.
The blood-forming function is one of the main places where the red bone marrow is located, in it, from stem cells, maturation takes place to blood cells.
Participation in mineral metabolism (calcium and phosphorus depot).

Greater trochanter of the femur

Universal Russian-English Dictionary. Academic.ru. 2011.

small trochanter - (trochanter minor, PNA, BNA, JNA) protrusion on the proximal epiphysis of the femur, located medial and below its neck; the place of attachment of the iliopsoas muscle ... Comprehensive Medical Dictionary

Muscles of the lower extremities - divided into the muscles of the pelvic girdle, muscles of the thigh, muscles of the lower leg and muscles of the foot. Contents 1 Muscles of the pelvic girdle 1.1 Anterior group ... Wikipedia

Thigh - I Thigh (femur) segment of the lower limb, bounded from above by the inguinal and gluteal folds, and from below by a line drawn 4-6 cm above the upper edge of the patella.

The skeleton of the free part of the lower limb - (pars libera membrae inferioris) is made up of the femur, patella, shin bones and foot bones. Femur (os femoris) (Fig.

Femur - Femur, os femoris, the longest and thickest of all the long bones of the human skeleton. It distinguishes between a body and two proximal and distal pineal glands.

HIP JOINT - HIP JOINT, articulatio coxae (coxa, ae is an Old Latin word; French cuisse), Vesalius' term. The joint is formed by the head of the femur and an unnamed glenoid (fossa acetabuli).

Femur - Bones of the free lower limb: The femur is the largest bone in a human organ. The bone is tubular and at its upper end is the head, the watering can, the greater and lesser trochanters.

Fractures of the neck and acetabular region of the femur

Fracture of the femoral neck is one of the most difficult and dangerous injuries, accounting for approximately 6% of all fractures.

In most cases, it is the elderly who suffer from this kind of fracture, this is associated with such a disease as osteoporosis.

With this disease, bone density decreases, which significantly increases the risk of fracture, even with a slight traumatic force.

Using vector diagrams, it has been calculated that during the stance phase of gait, 4 times more body weight is transferred to the bearing surface of the hip joint.

Mechanism and causes

To fully restore the motor functions of the joint, it is necessary to follow the recommendations of a physiotherapist. He will select the optimal procedures for the patient, taking into account the characteristics of his body and contraindications.

The use of cold, ultrasound, heating and UHF helps to relieve puffiness and pain. Using heat or cold is a convenient home-based method.

But now, with the advent of new X-ray equipment, the control guide wire is carried out in the center of the neck under visual control. The operation has become technically simple.

Fractures with a decrease in the cervico-diaphyseal angle - adduction (drive);

Avulsion fractures of the lesser trochanter also occur as a result of sudden sudden contractions of the iliopsoas muscle.

Femoral necrosis is a serious disease that develops as a result of a violation of the structure, nutrition or fatty degeneration of bone tissue. The main cause of the pathological process developing in the structure of the femur is a violation of blood microcirculation, osteogenesis processes and, as a consequence, the death of bone tissue cells.

Regular exercises for the hip joint.

There are several burs between the gluteal muscles and the wing of the ilium, as well as between the three gluteus muscles. Their function is to reduce friction between muscle layers during vigorous activity.

Using walking aids such as canes or crutches for a week or more

: The sooner the patient gets to his feet and begins to move independently, the higher the chances of recovery.

The operation of closed osteosynthesis of a fracture of the femoral neck is performed under anesthesia or local anesthesia. First, a closed reposition of the fragments is performed.

Varus with a vertical or vertically oblique fracture plane.

Thus, in the occurrence of fractures of the proximal end of the femur, involutive changes, neurotrophic lesions of the bone, osteoporosis, loss of muscle elasticity, limitation of the range of motion in the joint, a decrease in the protective reaction of muscles in older and elderly people, the direction, area and strength of the traumatic force play a role. ...

There are 4 stages of femoral necrosis:

Causes

The most common factors that contribute to the development of the disease are the following:

trauma;
disturbances in the process of calcium metabolism; congenital dysplasia of the joint;
malfunctioning of the thyroid gland.
aging of the body (violation of the structure of the bone and ligaments);
constant monotonous loads on the hip joint;
an infectious infection that develops in the surrounding tissues;
arthritis, arthrosis and other inflammatory processes in the joints, etc.

It is as a result of falling on the side, on the site of the greater trochanter, in older people, fractures of the femoral neck and acetabular site occur.

As you know, older and elderly people always have pronounced progressive osteoporosis.

The degree of its manifestation depends not only on the person's age, but also on concomitant diseases, physical activity. In addition to these general factors, the quality of the blood supply, especially the head and neck, affects the condition of the proximal end of the femur.

With age, the blood supply to the head and neck becomes more complicated due to obliteration of the artery of the femoral head, which runs in the round ligament, and the state of the vessels in the sclerotic fibrous capsule of the joint.

All these factors lead to an intensive increase in osteoporosis in the proximal end of the femur, especially in the area of the Ward's triangle, the Adams arch.

In addition, in older and elderly people, significant manifestations of degenerative-dystrophic changes in the spine (osteochondrosis, deforming spondylosis with secondary recurrent polyradiculitis) worsen muscle trophism against the background of involutive processes.

Muscles lose their elasticity, strength, endurance, especially in the case of a limited range of motion in the hip joint, their defensive reaction and grouping ability decrease.

This leads to a decrease in the protective function, and therefore the impact when falling falls directly on the large trochanter, which protrudes.

In cases where the head more or less retains its structure and the acting traumatic force is directed along the axis of the neck, a fracture of the bottom of the acetabular fossa or a central dislocation of the hip occurs.

When the traumatic force acts somewhat at an angle from below outside the acetabular region with the adducted femur with external rotation, the neck under the head rests against the lower edge of the acetabular fossa, a subcapital fracture occurs.

Traumatic force and contraction of the gluteal muscles displace the distal fragment upward, an adduction fracture (coxa vara traumatica) occurs.

Due to the action of the traumatic force outside and slightly above the acetabular region, aimed at unbending the neck-femoral angle, an abduction fracture (coxa valga traumatica) occurs.

Under the action of a traumatic force from above and from the outside on the trochanter site, isolated fractures of the greater trochanter occur.

In adolescents who have not yet developed synostosis of the greater trochanter, a sudden sharp contraction of the gluteal muscles leads to the separation of the greater trochanter, and with the tangential action of the traumatic force, epiphyseolysis of the greater trochanter occurs.

Avulsion fractures of the lesser trochanter also occur as a result of sudden sudden contractions of the iliopsoas muscle.

Symptoms

But with a detailed clinical examination, it is possible to carry out a differential diagnosis.

Abduction fractures of the femoral neck are not characterized by significant external rotation of the limb. There is a slight inward displacement of the axis of the lower limb, the apex of the greater trochanter is on the Roser-Nelaton line, there is no relative shortening of the limb.

Pressure on the heel along the axis of the lower limb or tapping on it causes an aggravation of pain in the hip joint, Briand's triangle is isosceles, Shemaker's line passes over the navel.

Shemaker's line runs below the navel, the isosceles of Briand's triangle is broken. Passive movements and loads along the axis of the limb exacerbate pain in the hip joint.

In people with not very developed subcutaneous fatty tissue, the pulsation of the femoral artery under the inguinal ligament is clearly visible.

Acetabular region

The injured limb is significantly rotated outward.

The outer surface of the acetabular region is flattened, the contour of the greater trochanter is smoothed, widened, its apex is higher than the Roser-Nelaton line.

Briand's triangle is broken and Shemaker's line runs below the navel. On palpation, the intensity of pain increases with direct contact with the swivel itself.

In case of displacement of the fragments, the protrusion at the site of the fracture of the greater trochanter is palpated. Active movements of the limb are impossible, passive ones are significantly limited due to exacerbation of pain in the acetabular region.

Large skewer

In young men, with the tangential action of a traumatic force and a sudden, abrupt, excessive contraction of the gluteal muscles, the greater trochanter is detached.

There is a sharp pain along the outer surface of the area of the hip joint.

The victim can walk on his own, but at the same time the injured limb is not actively carried forward, but pulls it up one step at a time with a healthy one. Can actively bend the leg at the hip joint, feeling a moderate exacerbation of pain.

The victim cannot actively abduct the hip in the hip joint. Rotational movements exacerbate pain in the greater trochanter region.

In people with insufficiently developed subcutaneous tissue with fractures of the greater trochanter with displacement of fragments or multi-splinter fractures, deformation of the contours of the greater trochanter is clearly visible, its apex is located above the Roser-Nelaton line.

On palpation, the pain is exacerbated by direct contact with the greater trochanter, and with significant displacements, there is diastasis between the fragments.

Fractures of the lesser trochanter are observed in adolescence, when synostosis with the femur has not yet occurred, and, in fact, a fracture of the lesser trochanter is an avulsion fracture of the apophysis.

The detachment of the lesser trochanter occurs mainly in boys during jumping, that is, due to a sharp, sudden, excessive contraction of the iliopsoas muscle, while there is a sharp pain in the depths of the base of the femoral triangle.

The victim loads the lower limb, walks independently, tilting the body forward, dragging his leg. On palpation, the severity of pain is localized in the projection of the lesser trochanter.

The victim leads the hip, withdraws, but cannot actively bend it, while passive flexion is possible in full (positive Ludloff symptom).

So, when the small trochanter is detached, only the function of the iliopsoas muscle is disturbed, and the function of the gluteal muscles, adductors and rotational ones, does not suffer.

The final diagnosis is established after an X-ray examination, which makes it possible to confirm the clinical diagnosis, to reveal the structure of the proximal end of the femur, which is necessary to substantiate and select an effective tactics and method of treatment.

In case of fractures of the femoral head, the number of fragments and their position are found, in case of neck fractures - the place of the fracture, features of the plane of the fracture, the nature of the angular displacement of the fragments.

Cervical fractures

Due to the fact that fractures of the femoral neck are intra-articular, the joint capsule limits significant displacements in length, width, and displacement occurs mainly at an angle, that is, there is a decrease or increase in the cervico-diaphyseal angle.

Among the fractures of the femoral neck are:

fractures with a decrease in the cervico-diaphyseal angle - adduction (drive);
varus with a vertical or vertically oblique fracture plane.

From a biomechanical point of view, adduction fractures are unfavorable for the process of reparative regeneration due to the instability of the fragments, which is caused by the constant contraction of the gluteal muscles.

In addition, with a vertical or vertically oblique plane of the fracture, a shearing force constantly acts, which destroys the restoration of the vascular network and disrupts reparative regeneration.

This causes the formation of false joints and resorption of the femoral neck.

With abduction (valgus) fractures of the femoral neck, the cervico-diaphyseal angle increases, which in turn leads to an increase in the tone of the gluteal muscles and knitting of fragments with the exclusion of any mobility between them.

This becomes a positive factor for the process of reparative regeneration.

For transcervical fractures, the vertical oblique plane of the fracture is typical, and most basal fractures are impacted with a decrease in the cervico-diaphyseal angle (traumatic coxa vara).

Among the fractures of the acetabular region, the first place is taken by the pertrochanteric ones with a fracture or detachment of the lesser trochanter, in the second place are the multi-splintered ones, in the third place are the intertrochanteric ones.

With acetabular fractures, the fragments are displaced in length and width more than in neck fractures. This is due to the fact that all fractures of the acetabular region are extra-articular and the displacement of the fragments is not limited to the capsule.

Isolated fractures of the greater trochanter have a transverse oblique fracture plane and are often multi-splintered.

Most isolated fractures of the lesser trochanter have an oblique fracture plane. The proximal displacement of the lesser trochanter occurs under the action of the iliopsoas muscle.

Of the general signs that are characteristic of this disease, one can single out:

pain when moving the leg;
sharp pains that appear during palpation;
the sound of crunching and crackling while driving;
the skin at the site of the lesion turns red;
the body temperature in the affected area rises;
the joint is limited in mobility.

This disease is characterized by the fact that the pain at first does not appear strong enough, but over time it increases and tendinosis worsens. This can happen at different times of the day.