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THE

BONY PELVIS

AUP COM April 12, 2016

PELVIS
.

. . Region where the trunk and


lower limbs meet
. . . basin
. . . Skeleton of the region

HIP BONE (PELVIC B., INNOMINATE B.)


Composition of the Hip Bone
The HIP BONE is made up of the three parts
theilium, pubis and ischium.Prior to
puberty,thetriradiate cartilage separates
these constituents. At the age of 15-17, the three
parts begin to fuse.
Their fusion forms a cup-shaped socket known as
the acetabulum, which becomes complete at2025 years of age.The head of the femur
articulates with the acetabulum to form the
hip joint.

BONY PELVIS COMPRISED OF


4 BONES

Innominate bone (Ilium, ischium and pubis)


Sacrum
Coccyx
Joined anteriorly by pubic symphysis
Posteriorly by sacro-iliac joint

THE HIP BONES HAVE THREE ARTICULATIONS:


Sacroiliac joint articulation with
sacrum.
Pubic symphysis articulation with the
corresponding hip bone.
Hip joint articulation with the head of
femur.

THE ILIUM

The wing of the ilium has two surfaces.


The inner surface is concave, and known
as the iliac fossa, providing origin to the
iliacus muscle. The external surface is
convex, and provides attachments to the
gluteal muscles. Hence it is known as the
gluteal surface.

The superior part of the hip


bone is formed by the ilium,
the widest and largest of the
three parts. The body of the
ilium forms the superior part
of the acetabulum.
Immediately above the
acetabulum, the ilium expands
to form the wing (or ala).

Muscles attaching to the Ilium:


Gluteal muscles attach to the
external surface of the Ilium at
the anterior, posterior and
inferior gluteal lines.
The iliacus muscle attaches
medially at the iliac fossa.

The superior margin of the


wing is thickened, forming
theiliac crest.Itextends
from the anterior superior iliac
spine to the posterior superior
iliac spine.

CLINICAL RELEVANCE: ANTERIOR SUPERIOR


ILIAC SPINE

The anterior superior iliac spine (ASIS) is an


important landmark, serving as the attachment
site of the inguinal ligament,which runs from
the ASIS to the pubic tubercle. Midway along the
inguinal ligament, the femoral artery can be
palpated, with the femoral vein lying medially.
In clinical practice, a patients true leg length
is measured from the ASIS to the medial
malleolus at the ankle joint. This is distinct from
apparent leg length, which is measured from
the umbilicus to the medial malleolus. True leg
length discrepancy can seen in various hip
disorders.

THE PUBIS
The pubis is the most anterior portion of the hip
bone. It consists of a body and superior and
inferior rami (branches).
The body is located medially, articulating with its
opposite pubic body, at the pubic symphysis.

The Pubis

(cont)

The superior rami extends laterally from


the body, forming part of the acetabulum.
The inferior rami projects towards, and joins
the ischium. Together, the two rami enclose
part of the obturator foramen, through
which the obturator nerve, artery and vein
pass through to reach the lower limb.

THE ISCHIUM
The posterioinferior part of the
hip bone is formed by the
ischium.
Muchlike the pubis, it is
composed of a body, an inferior
and a superior ramus.
The inferior ischial ramus
combines with the inferior
pubic ramus forming the
ischiopubic ramus which
encloses part of the obturator
foramen.

THE ISCHIUM (CONT)


The posterorinferior aspect of the ischium forms
the ischial tuberosities and when sitting, it is
these tuberositieson which our body weight falls.
On the posterior aspect of the ischium there is an
indentation known as the greater sciatic
notch, with the ischial spine at its most
inferior edge.

SUPERIOR APERTURE

BONY PELVIS

INFERIOR PELVIC BORDER

1. Identify the bony walls and ligamentous landmarks of the pelvis.


Iliopectineal Line

Sacrotuberous
Ligament
Sacrospinous
Ligament

Greater
Sciatic
Foramen
Lesser
Sacrospinous
Sciatic
Ligament
Foram
en
Sacrotuberous
Ligament
Pubic
Symphysis
Pubic Arch
Ischial Tuberosity

Ant. Sup. Iliac Spine


Pubic symphysis

Tip of Coccyx

Sacrotubero
usCoccyx
Ligament

Pel
vic
Out
let

MUSCULAR WALLS
Piriform
is
Muscle
Sacrotube
rous
Ligament

Greate
r
Sciatic
Forame
n

Sacrospi
nous
Ligame
Sacrotuberou
nt
s Ligament

Piriform
is
Muscle

Gemell
us
Superi
Greater
or & Trochant
Inferio
Obturator Internus
r
Ischial Tuberosity
Lesser Trochanter

MALE VS. FEMALE PELVIS


Female
Pelvic Inlet
Pelvic Outlet
Pelvic Cavity

Pelvic Arch

Male

FEMALE PELVIS

MALE PELVIS

GREATER PELVIS (PELVIS MAJOR)


Location of some abdominal viscera (ileum and
sigmoid colon)
Bounded by abdominal wall anteriorly, the iliac
fossa posteriolaterally and L5 S1 vertebrae
posteriorly
AKA False Pelvis

LESSER PELVIS ( PELVIS MINOR)


Location of pelvic viscera the urinary bladder
and reproductive organs such as the uterus and
ovaries
Bounded by the pelvic surfaces of the hip bones,
sacrum, and coccyx
Limited inferiorly by the musculofascial pelvic
diaphragm
AKA True Pelvis

PELVIC WALLS AND FLOORS


Anterior pelvic wall is formed primarily by
the bodies and rami of the pubic bones and the
pubic symphysis
Lateral pelvic walls formed by the hip bones
and the obturator internus muscles (O: proximal
surface of the ilium and ischium; obturator
membrane I: greater trochanter of the femur)

POSTERIOR PELVIC
WALL

PELVIC FLOOR
Formed by the funnel shaped pelvic diaphragm
consists of the levator ani and coccygeus muscles
and their fascia
Stretches between the pubis anteriorly and the
coccyx posteriorly and from one lateral pelvic wall
to the other

PELVIC DIAPHRAGMQA

PELVIC FLOOR MALE

PELVIC FLOOR - FEMALE

LEVATOR ANI

Consists of three parts the pubococcygeus, the


puborectalis and the iliococcygeus.
Collectively they run from the body of the pubis, the
tendinous arch of the obturator fascia and the ischial
spine TO the perineal body, the coccyx, the
anococcygeal ligament, the walls of the prostate or
vagina, the rectum and the anal canal
Innervated by the nerve to levator ani from S4 and
the inferior anal (rectal) nerve (from S2-S4) and the
coccygeal plexus
Help to support the pelvic viscera; acting together
they raise the pelvic floor and assist the abdominal
muscles in forced expiration activities

PERINEAL
BODY

COCCYGEUS MUSCLE
O: ischial spine, I: inferior end of the sacrum, I:
branches of S4 and S5
Forms a small part of the pelvic diaphragm that
supports the pelvic viscera, flexes the coccyx