Bones, joints, construction of the pelvis

1. Bones, joints, construction of the pelvis Dr. Szuák András ÁOK 2017.10.24.

2. Bones of the pelvis hip bone hip bone sacrum

3. Bones of the pelvis - sacrum promontory # # * * * * # # median sacral crest intermediate sacral crest lateral sacral crest *: pelvic sacral foramina #: dorsal sacral foramina

4. Bones of the pelvis – hip bone ace- tabu- lum obtu- rator foramen obtu- rator foramen

5. Bones of the pelvis – hip bone ilium ilium ischium ischium pubis pubis

6. Bones of the pelvis – hip bone iliac crest ala of ilium auricular surface ant. sup. iliac spine ant. inf. iliac spine post. sup. iliac spine post. inf. iliac spine arcuate line pecten pubis greater sciatic notch superior pubic ramus ischial spine lesser sciatic notch symphyseal surface ischial tuberosity inferior pubic ramus

7. Bones of the pelvis – hip bone iliac crest ala of ilium ant. sup. iliac spine ant. inf. iliac spine post. sup. iliac spine post. inf. iliac spine greater sciatic notch ischial spine superior pubic ramus lesser sciatic notch ischial tuberosity inferior pubic ramus

8. Joints of the pelvis sacroiliac joint pubic symphysis hip joint

9. Sacroiliac joint • auricular surface of sacrum&hip bone • plane joint • the articular surfaces are covered by FIBROCARTILAGE • ligaments • ant. sacroilicac • inteross. sacroiliac • post. sacroiliac

11. Pubic symphysis • articularsurfaces of pubis • planejoint* • disc - fibrocartilage * Joint? Synchondrosis?

12. Hip joint • acetabulum – head of femur • acetabulum, lunate surface + transverse acetabular ligament • acetabular labrum • ball-and-socket • lig. of head of femur • strong parts of capsule • circular – zona orbicularis • oblique – iliofemoral, ischiofemoral and pubofemoral ligaments

13. Ligaments

14. Movements of the hip anteflexion-retroflexion (transverseaxis) internal-externalrotation (longitudinalaxis) abduction-adduction (sagittalaxis)  circumduction

15. Other inguinal ligament obturator membrane

16. Pelvic inlet – lesser pelvis promontory ala of sacrum symphysis arcuate line pecten pubis symphysis, superior border

17. Pelvic outlet symphysis symphysis, inferior border inferior pubic ramus ischiadial tuberosity sacrotuberous lig.

18. Wall of lesser pelvis greater sciatic foramen sacrospinous lig. sacrotuberous lig. obturator canal lesser sciatic foramen

19. Planes, diameters of lesser pelvis a: pelvicinlet – 60-65° bends (inclination) (thesagittaldiameter is theconjugate) b: pelvicamplitudo (widest) c: pelvicangustia (narrowest) d: pelvicoutlet pelvic axis a b c d

20. Conjugate a: anatomicalconjugate 12 cm b: trueconjugate (obstetric) 11.5 cm c: diagonalconjugate 13 cm a b c

21. 11 cm 12 cm 13 cm oblique diameter transverse diameter median conjugate Pelvicinlet Widest: transversediameter interspinous distance (25-26 cm) intercristal distance (28-29 cm)

22. Pelvicoutlet straightconjugate 9cm transversediameter 11cm

23. Widest dimeters • Pelvic inlet transverse: 13-13.5 cm • Pelvic amplitudo oblique: 14 cm • Pelvic outlet sagittal: 9.5-11.5 cm

24. Birth transverse oblique During birth, the head turns 90° in pelvis! sagittal

25. pubic arch subpubic angle

26. Construction of the pelvis X „teeter totter in a vice”

27. Construction of the pelvis „teeter totter in a vice”

28. Forces in standing position The verticalforce is puttowardstheacetabulumbytheupperarch, whichpullsthesymphisis upperarch lowerarch

29. Center of gravity Passes through the following structures: -atlantooccipital joint - lower lumbar vertebrae, in front of promontory - middle of head of femur - highest point of longitudinal plantar arch Weight and support in one line! Onlypossible if the pelvis is bent 60-65° to the front! – Inclination Ant. sup. iliac spine and symphysis are in the same frontal plane Ant. and post. sup. iliac spine are in the same horizontal plane

30. Trabecularstructure hipbone, leftside, medialsurface Pushingforcefromauricularsurfaceto top of acetabulum Trabecules from body of ischiumtoinf. ramus of pubis Trabeculesfromanterior part of lunatesurfacetosup. ramus of pubis acetabular fossa

31. Trabecularstructure Acetabulum trabecules in femur

32. Sitting position Weight of upper body -Pelvicinlet is horizontal -Sacrumstandsvertical -Sacrumwedgesbetweenhipbones -Holdedbythedorsalligaments The weight of the body is puttowardstheischialtuberosity, whichmakesforceonthesymphysis ischialtuberosity Forcesonsymphysis: - pushed in men - pulled in women

33. Normal pelvis x-ray

34. Symphysis diastasis

35. Arthrosis

36. Dysplasia

37. Fracture

39. Thank you for your attention!