Femur: Difference between revisions
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== Overview ==
== Introduction ==
[[File:Femur bone.png|right|frameless|801x801px]]
The femur is the longest, heaviest, and strongest [[bone]] in the human body. The main function of the femur is [[weight bearing]] and stability of [[Gait|gait.]] An essential component of the lower [[Closed Chain Exercise|kinetic chain]].


The femur is the largest and strongest bone in the body. Osteologic features of this long bone include the femoral head and neck, greater and lesser trochanters at the proximal end, the femoral shaft, and the femoral condyles distally.  
The robust shape of the femur provides many sturdy attachment points for the powerful [[:Category:Hip - Muscles|muscles of the hip]] and [[:Category:Knee - Muscles|knee]] that contribute to [[Walking - Muscles Used|walking]] and other propulsive movements.<ref name="Moore">Moore KL, Agur AM, Dalley AF. Essential Clinical Anatomy. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins, 2011.</ref>


[[Image:Femur Anterior.png|400px]] {{#ev:youtube| Xb-U3Jjj-n4|300}}
== Femur: Three Divisions ==
The femur acts as the site of origin and attachment of many muscles and [[Functional Anatomy of the Hip-Bones and Ligaments|ligaments]], and can be divided into three parts; proximal, shaft and distal. <ref name=":0">Chang A, Breeland G, Hubbard JB. [https://www.ncbi.nlm.nih.gov/books/NBK532982/ Anatomy, Bony Pelvis and Lower Limb, Femur.] InStatPearls [Internet] 2019 Jul 3. StatPearls Publishing.Available from:https://www.ncbi.nlm.nih.gov/books/NBK532982/ (last accessed 16.6.2020)</ref>
[[File:Femur front.png|right|frameless|939x939px]]
'''Proximal Femur: C'''omposed of the head, neck, greater trochanter and lesser trochanter. The head of the femur articulates with the acetabulum of the [[pelvis]] to create the [[Hip Anatomy|hip joint]].


== Osteologic Features  ==
# Femoral head: Supported by the neck of the femur.Is a globular form rather more than a hemisphere. It is directed caudally, medially and anteriorly, known as the angle of inclination. Normal 120 degrees, abnormal angles; [[Coxa Vara / Coxa Valga|coxa vara]] less than 125 degrees; [[Coxa Vara / Coxa Valga|coxa valga]] greater than 125 degrees. Its surface is smooth and coated in [[cartilage]] except for an ovoid depression, fovea capitis femoris (a little below and behind the centre of the head). The fovea allows for the attachment of the ligament of head of the femur.
# The bulbous femoral head is joined to the shaft of the femur by the femoral neck. If there is a [[Femoral Neck Hip Fracture|femoral neck fracture]], the blood supply through the ligament becomes crucial, and there is a risk of [[Avascular necrosis of the femoral head|avascular necrosis.]]
# At the base of the neck are the medially oriented lesser trochanter and laterally placed greater trochanter. A rough line called the intertrochanteric line connects the greater and lesser trochanter on the anterior aspect of the femur, while the smoother intertrochanteric crest connects the trochanters posteriorly.<ref name="Moore" /><ref name="Neumann" />


=== Proximal Femur  ===
'''Femoral Shaft'''


At the proximal end of the femur, the bulbous femoral head is joined to the shaft of the femur by the femoral neck. At the base of the neck are the medially oriented lesser trochanter and laterally placed greater trochanter. A rough line called the intertrochanteric line connects the greater and lesser trochanter on the anterior aspect of the femur, while the smoother intertrochanteric crest connects the trochanters posteriorly.<ref name="Moore" />  
The femoral shaft is almost cylindrical in form, being slightly broader superiorly and slightly arched, giving it a convexity anteriorly and concavity posteriorly which has a prominent longitudinal ridge of bone, the linea aspera. A variety of muscles have their origins at and insert into the femoral shaft (all, apart from gluteus maximus and vastus intermedius, interact with the posterior surface of the bone).<ref name=":1">Teach me anatomy [https://teachmeanatomy.info/lower-limb/bones/femur/ Femur] Available from:https://teachmeanatomy.info/lower-limb/bones/femur/ (last accessed 16.6.2020)</ref>


==== Angle of Inclination  ====
'''Distal Femur'''


The angle between the femoral neck and the medial side of the femoral shaft viewed from the frontal plane is known as the angle of inclination. This angle is greater at birth but decreases during childhood and adolescent development due to loading stresses across the femoral neck in weight-bearing and walking. Ideally, a normal angle of inclination of 125 degrees increases mobility of the femur at the hip joint by placing the femoral head and neck in a biomechanically favourable position for walking. Abnormal angles, known as coxa vara for an angle much less than 125 degrees and coxa valga for an angle much greater than 125 degrees, alter hip biomechanics, leading to malalignment and complications.<ref name="Moore" /><ref name="Neumann" />  
Prominent lateral and medial condyles are found at the distal end of the femur. Projecting from each condyle is an epicondyle that act as attachment sites for the collateral ligaments. The lateral and medial condyles are separated by the intercondylar notch.<ref name="Neumann" />  


[[Image:Femur Angles of Inclination.jpg|center|300px]]
== Blood Supply ==
 
The femoral artery is the main blood supply to the lower extremity. The foveal artery comes off of the obturator artery that runs through the ligamentum teres femoris as supportive blood supply to the femoral head, but it is not the main source during adulthood. The perforating branches of the deep femoral artery supply the shaft and distal portion of the femur.<ref name=":0" />See also [[Functional Anatomy of the Hip - Neural and Vascular]]
=== Femoral Shaft ===
== Muscles ==
 
[[File:Quadriceps muscle.jpg|right|frameless|450x450px]]
The shaft of the femur courses on an oblique lateral to medial angle, functioning to bring the alignment of the knees and feet closer to midline.<ref name="Neumann" /> The ridge-like linea aspera runs along the posterior aspect of the shaft.<ref name="Moore" />  
The thigh muscles are divided into the anterior, medial, and posterior and gluteal compartments. The femur sits within the anterior compartment.
 
# Anterior compartment is composed of the  [[Hip Flexors|hip flexors]] and [[Knee Extensors|knee extensors]]. Hip flexors include pectineus, iliopsoas, and sartorius muscle.
=== Distal Femur ===
# Medial compartment’s function is mainly leg adduction. See [[Hip Adductors]]
 
# Posterior compartment muscles are mainly hip extensors and knee flexors. [[Hip Extensors|Hip extensors]] [[Knee Flexors]]
Prominent lateral and medial condyles are found at the distal end of the femur. Projecting from each condyle is an epicondyle that act as attachment sites for the collateral ligaments. The lateral and medial condyles are separated by the intercondylar notch.<ref name="Neumann" />  
# [[Gluteal Muscles|Gluteal]] muscles. 1.The superficial layer is composed of the gluteus maximus, medius, and minimus. Hip extension, abduction, and internal rotation is the superficial gluteal’s main function. 2. The deep layer is made up of the piriformis, obturator internus, quadratus femoris, and superior and inferior gemellus (deeper gluteal muscles help with external rotation of the hip)<ref name=":0" />.


== Articulations  ==
== Articulations  ==
 
# The femoral head of the proximal femur articulates with the acetabulum of the pelvis in which the femoral head acts at the ball and the acetabulum as the socket. Allows for movement at the [[Hip|hip]] in three [[Cardinal Planes and Axes of Movement|planes]]: flexion and extension in the sagittal plane, abduction and adduction in the frontal plane, and internal and external rotation in the horizontal plane.<ref name="Neumann">Neumann DA, Kinesiology of the musculoskeletal system: Foundations for rehabilitation. 2nd ed. St. Louis, MO: Mosby Elsevier, 2010. p520-71.</ref>
The femoral head of the proximal femur articulates with the acetabulum of the pelvis, forming a "ball-and-socket" joint, in which the femoral head acts at the ball and the acetabulum as the socket. This formation allows for movement at the [[Hip|hip]] in three [[Cardinal Planes and Axes of Movement|planes]]: flexion and extension in the sagittal plane, abduction and adduction in the frontal plane, and internal and external rotation in the horizontal plane.<ref name="Neumann">Neumann DA, Kinesiology of the musculoskeletal system: Foundations for rehabilitation. 2nd ed. St. Louis, MO: Mosby Elsevier, 2010. p520-71.</ref>  
# Distally, the convex femoral condyles of the femur articulate with the condyles of the [[Tibia|tibia]], ie [[Knee|tibiofemoral joint]]. Movement at the tibiofemoral joint occurs in two planes: knee flexion and extension in the sagittal plane, and internal and external rotation in the horizontal plane.<ref name="Neumann" />
 
# The patellofemoral joint is formed by the articulation of the [[patella]] with the intercondylar/trochlear groove of the femur. During flexion and extension of the knee, the articular surfaces of the patella and femur perform a sliding movement.<ref name="Neumann" />
Distally, the convex femoral condyles of the femur articulate with the condyles of the [[Tibia|tibia]], forming the [[Knee|tibiofemoral joint]]. Movement at the tibiofemoral joint occurs in two planes: knee flexion and extension in the sagittal plane, and internal and external rotation in the horizontal plane.<ref name="Neumann" /><br>  
 
The patellofemoral joint is formed by the articulation of the [[Patella|patella]] with the intercondylar/trochlear groove of the femur. During flexion and extension of the knee, the articular surfaces of the patella and femur perform a sliding movement.<ref name="Neumann" />  
 
== Functions  ==
 
As the largest and strongest bone in the body, the femur serves an important weight-bearing function and is an essential component of the lower kinetic chain. The robust shape of the femur provides many sturdy attachment points for the powerful muscles of the hip and knee that contribute to walking and other propulsive movements.<ref name="Moore">Moore KL, Agur AM, Dalley AF. Essential Clinical Anatomy. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins, 2011.</ref>
 
==Video==
 
{{#ev:youtube|wJqftUJU1io}}


== Injuries and Conditions  ==
== Injuries and Conditions  ==
[[File:Femoral-shaft-fracture.jpeg|thumb|220x220px|Femoral Shaft Fracture]]See:


[[Femoral Fractures|Femoral fractures]] can occur at the femoral head, shaft, or condyles, with a fracture of the femoral neck being the most commonly fractured location. Osteoporosis is a significant risk factor for fractures of the femoral neck.<ref name="Moore" />  
* [[Femoral Fractures|Femoral fractures]]
 
* <u>[[Femoral stress fracture|Femoral Stress fracture]]</u>
[[Patellofemoral Pain Syndrome|Patellofemoral pain syndrome]] (PFPS) is a common sports-related injury that presents as pain around or behind the patella, typically with an insidious onset. The cause of the condition is unclear, but neurologic, genetic, neuromuscular and/or biomechanical factors may contribute to its development.<ref name="Neumann" />  
* [[Patellofemoral Pain Syndrome|Patellofemoral pain syndrome]] .<ref name="Neumann" />.<ref>Fullem BW.Overuse lower extremity injuries in sport
 
<u>Femoral Stress fracture&nbsp;</u><br>A femoral stress fracture is a condition characterized by an incomplete crack in the femur (thigh bone).<ref>Fullem BW.Overuse lower extremity injuries in sport
Clin Podiatr Med Surg. 2015 Apr;32(2):239-251. doi: 10.1016/j.cpm.2014.11.006. Epub 2014 Dec 30. Review.
Clin Podiatr Med Surg. 2015 Apr;32(2):239-251. doi: 10.1016/j.cpm.2014.11.006. Epub 2014 Dec 30. Review.
PMID: 25804713</ref><br>Several muscles of the hip, knee and thigh attach to the femur. When these muscles contract, a pulling force is exerted on the bone. In addition, weight bearing activity places compressive forces on the femur. When these forces are excessive or too repetitive, and beyond what the bone can withstand, bony damage can gradually occur. This initially results in a bony stress reaction, however, with continued damage may progress to a femoral stress fracture.<br>Cause of a femoral stress fracture: A stress fracture of the femur typically occurs over time with excessive weight bearing activity such as running, sprinting, jumping or dancing. They often occur following a recent increase in activity or change in training conditions (such as surface, footwear or technique changes etc) and are particularly common in long distance runners.<br>Signs and symptoms of a femoral stress fracture: Patients with this condition typically experience a poorly localized pain in the front of the thigh that increases with impact activity (such as running, jumping, sprinting and hopping) and decreases with rest. Pain may also cause the patient to cease activity.<br>Occasionally, pain may radiate to the knee or back of the thigh. In severe cases, walking or standing may be enough to aggravate symptoms. Other symptoms may include night ache, pain when sitting with the thigh over the edge of a chair (especially if a downwards force is applied to the end of the thigh) or pain on firmly touching the affected region of the bone.<br>Diagnosis of a femoral stress fracture:&nbsp;A thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose a femoral stress fracture. Further investigations such as an X-ray, MRI, CT scan or bone scan are usually required to confirm diagnosis and determine the severity of injury.<ref>Wright AA, Hegedus EJ, Lenchik L, Kuhn KJ, Santiago L, Smoliga JM.Diagnostic Accuracy of Various Imaging Modalities for Suspected Lower Extremity Stress Fractures: A Systematic Review With Evidence-Based Recommendations for Clinical Practice.
PMID: 25804713</ref>
Am J Sports Med. 2015 Mar 24. pii: 0363546515574066</ref>
* [[Femoral Neck Fractures|Femoral Neck Fracture]]
 
* [[Greater Trochanteric Pain Syndrome]]
== References ==
== References ==
 
<references />
<references />


[[Category:Anatomy]] [[Category:Hip - Anatomy]] [[Category:Anatomy - Hip]] [[Category:Knee_Anatomy]] [[Category:Bones]] [[Category:Hip]] [[Category:Thigh]] [[Category:Knee]] [[Category:Musculoskeletal/Orthopaedics]] [[Category: Knee Bones]] [[Category:Bones of the Knee]] [[Category:Bones of the Hip]] [[Category:Hip Bones]]
[[Category:Anatomy]]  
[[Category:Hip - Anatomy]]
[[Category:Knee - Anatomy]]
[[Category:Bones]]  
[[Category:Hip]]
[[Category:Knee]]  
[[Category:Musculoskeletal/Orthopaedics]]  
[[Category: Knee - Bones]]
[[Category:Hip - Bones]]

Latest revision as of 12:08, 19 December 2022

Original Editor - Daphne Jackson

Top Contributors - Lucinda hampton, Kim Jackson, Evan Thomas, Admin, Daphne Jackson, Joanne Garvey, WikiSysop and Joao Costa

Introduction[edit | edit source]

Femur bone.png

The femur is the longest, heaviest, and strongest bone in the human body. The main function of the femur is weight bearing and stability of gait. An essential component of the lower kinetic chain.

The robust shape of the femur provides many sturdy attachment points for the powerful muscles of the hip and knee that contribute to walking and other propulsive movements.[1]

Femur: Three Divisions[edit | edit source]

The femur acts as the site of origin and attachment of many muscles and ligaments, and can be divided into three parts; proximal, shaft and distal. [2]

Femur front.png

Proximal Femur: Composed of the head, neck, greater trochanter and lesser trochanter. The head of the femur articulates with the acetabulum of the pelvis to create the hip joint.

  1. Femoral head: Supported by the neck of the femur.Is a globular form rather more than a hemisphere. It is directed caudally, medially and anteriorly, known as the angle of inclination. Normal 120 degrees, abnormal angles; coxa vara less than 125 degrees; coxa valga greater than 125 degrees. Its surface is smooth and coated in cartilage except for an ovoid depression, fovea capitis femoris (a little below and behind the centre of the head). The fovea allows for the attachment of the ligament of head of the femur.
  2. The bulbous femoral head is joined to the shaft of the femur by the femoral neck. If there is a femoral neck fracture, the blood supply through the ligament becomes crucial, and there is a risk of avascular necrosis.
  3. At the base of the neck are the medially oriented lesser trochanter and laterally placed greater trochanter. A rough line called the intertrochanteric line connects the greater and lesser trochanter on the anterior aspect of the femur, while the smoother intertrochanteric crest connects the trochanters posteriorly.[1][3]

Femoral Shaft

The femoral shaft is almost cylindrical in form, being slightly broader superiorly and slightly arched, giving it a convexity anteriorly and concavity posteriorly which has a prominent longitudinal ridge of bone, the linea aspera. A variety of muscles have their origins at and insert into the femoral shaft (all, apart from gluteus maximus and vastus intermedius, interact with the posterior surface of the bone).[4]

Distal Femur

Prominent lateral and medial condyles are found at the distal end of the femur. Projecting from each condyle is an epicondyle that act as attachment sites for the collateral ligaments. The lateral and medial condyles are separated by the intercondylar notch.[3]

Blood Supply[edit | edit source]

The femoral artery is the main blood supply to the lower extremity. The foveal artery comes off of the obturator artery that runs through the ligamentum teres femoris as supportive blood supply to the femoral head, but it is not the main source during adulthood. The perforating branches of the deep femoral artery supply the shaft and distal portion of the femur.[2]See also Functional Anatomy of the Hip - Neural and Vascular

Muscles[edit | edit source]

Quadriceps muscle.jpg

The thigh muscles are divided into the anterior, medial, and posterior and gluteal compartments. The femur sits within the anterior compartment.

  1. Anterior compartment is composed of the hip flexors and knee extensors. Hip flexors include pectineus, iliopsoas, and sartorius muscle.
  2. Medial compartment’s function is mainly leg adduction. See Hip Adductors
  3. Posterior compartment muscles are mainly hip extensors and knee flexors. Hip extensors Knee Flexors
  4. Gluteal muscles. 1.The superficial layer is composed of the gluteus maximus, medius, and minimus. Hip extension, abduction, and internal rotation is the superficial gluteal’s main function. 2. The deep layer is made up of the piriformis, obturator internus, quadratus femoris, and superior and inferior gemellus (deeper gluteal muscles help with external rotation of the hip)[2].

Articulations[edit | edit source]

  1. The femoral head of the proximal femur articulates with the acetabulum of the pelvis in which the femoral head acts at the ball and the acetabulum as the socket. Allows for movement at the hip in three planes: flexion and extension in the sagittal plane, abduction and adduction in the frontal plane, and internal and external rotation in the horizontal plane.[3]
  2. Distally, the convex femoral condyles of the femur articulate with the condyles of the tibia, ie tibiofemoral joint. Movement at the tibiofemoral joint occurs in two planes: knee flexion and extension in the sagittal plane, and internal and external rotation in the horizontal plane.[3]
  3. The patellofemoral joint is formed by the articulation of the patella with the intercondylar/trochlear groove of the femur. During flexion and extension of the knee, the articular surfaces of the patella and femur perform a sliding movement.[3]

Injuries and Conditions[edit | edit source]

Femoral Shaft Fracture

See:

References[edit | edit source]

  1. ↑ 1.0 1.1 Moore KL, Agur AM, Dalley AF. Essential Clinical Anatomy. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins, 2011.
  2. ↑ 2.0 2.1 2.2 Chang A, Breeland G, Hubbard JB. Anatomy, Bony Pelvis and Lower Limb, Femur. InStatPearls [Internet] 2019 Jul 3. StatPearls Publishing.Available from:https://www.ncbi.nlm.nih.gov/books/NBK532982/ (last accessed 16.6.2020)
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Neumann DA, Kinesiology of the musculoskeletal system: Foundations for rehabilitation. 2nd ed. St. Louis, MO: Mosby Elsevier, 2010. p520-71.
  4. ↑ Teach me anatomy Femur Available from:https://teachmeanatomy.info/lower-limb/bones/femur/ (last accessed 16.6.2020)
  5. ↑ Fullem BW.Overuse lower extremity injuries in sport Clin Podiatr Med Surg. 2015 Apr;32(2):239-251. doi: 10.1016/j.cpm.2014.11.006. Epub 2014 Dec 30. Review. PMID: 25804713
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