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1920FrazerJES

 

Fragments from the book Frazer JES. Anatomy of the Human Skeleton (1920). The author describes anatomy, embryology, development, and attachment of the ligamentum capitis femoris (LCF).

 

Fig. 104. — Outer view of the acetabular and ischio-pubic regions. A. is a region on the bone in front of the position of Quadratus femoris which is in relation with the tendon of Obturator externus and some loose fibro-fatty tissue that permits changes in place of the tendon with movement of the joint. B. is a sloping surface of bone which supports Pectineus but does not give origin to it; the surface extends out to the ilio-pectineal eminence where the fascia covering the Pectineus (pubic portion of fascia lata) reaches the bone at a. The front of the eminence is roughened by fibres belonging to the pubo-femoral group of ligaments. These are separated from the ilio-femoral set by an interval, apparent on the bone and marking the limit of the secondarily added pubic area of articular surface (see Fig. 106), where the synovial cavity is protruded as the sub-Psoas bursa ; this is seen in the smaller figure. The Psoas lies on the bursa and the surface C. D. is covered by Gluteus minimus, which arises above the dotted line ; below D. the muscle lies on the reflected head of the Rectus and the capsule of the joint. O. and J.C. are branches of the obturator and internal circumflex arteries anastomosing round Obturator externus and giving twigs through the cotyloid notch into the cotyloid fossa and so into the lig. teres, which is attached round the margins of the fossa and to the transverse ligament that extends between the lips of the notch. X. marks an ill-defined depression on the margin, which indicates the spot where the origin of Adductor magnus passes from the outer side of the pubic ramus to the lower aspect of the ischial tuberosity ; it therefore also marks the hinder limit of origin of Gracilis.

 

Quote p. 126-127

The articular surface of the acetabulum surrounds on three sides the non-articular cotyloid or acetabular fossa, which contains the fatty tissue of the “ Haversian gland,” and opens below at the cotyloid notch. The notch is bridged across by the transverse ligament, a tendinous structure continuous with the fibro-cartilaginous cotyloid ligament that is attached to the whole length of the edge of the brim : vessels and nerves pass through the notch, under the transverse ligament, to enter the ligamentum teres. The fibrous basis of the ligamentum teres is attached to the ischial and iliac parts of the cotyloid fossa and to the transverse ligament : its synovial covering is attached to the whole margin of the fossa and the whole length of the transverse ligament below, covering the fossa but lying free on its surface. The round ligament is the remains of the original ventral wall of the capsule (Fig. 106). In the human embryo the Ischium and Ilium alone are concerned in the articulation with the femur and the capsule is attached round their ventral margin : the pubic cartilage is extracapsular. As the pubis extends it is still separated by the cellular capsule from the femur. Later it breaks through this capsule and becomes articular, the synovial cavity extending over it from the Ilium. In this way the original attachment of the capsule is only left on the Ischium as the fibrous basis of the Ligamentum teres. In the adult the pubic articular surface is still more or less distinct from the iliac surface, and the same distinction is usually marked on the rim by a shallow notch ; here the communication may take place of the joint with the sub-psoas bursa, between the Iliac and pubic parts of the capsule. Above this notch is the large rough area for the A-shaped Ilio-femoral band, spreading on to the lower half or more of the anterior inferior spine, and below and internal to it is the area for the pubo-femoral band which extends inward along the front edge of the upper pubic ramus, overhanging the issuing obturator nerve.

The direct tendon of the Rectus femoris is attached to the upper part of the anterior inferior spine, so that it rests on the ilio-femoral band at its origin : outside this the line of its attachment passes downwards and backwards, to run into the cotyloid ligament and capsule at the top of the acetabulum, thus forming the reflected head. Observe that this must be under cover of Gluteus minimus, arising above the inferior curved line (see Fig. 105).

At the back of the acetabulum synovial membrane comes over the cotyloid ligament and touches the bone : this occurs from the transverse ligament below to the reflected tendon of Rectus above. In front the synovial membrane does not transgress the cotyloid ligament, but passes nearly directly from it to the strong capsule.

There is only a slight capsular attachment behind the acetabulum, for there are no true transverse fibres on the back of the joint, and only a few of the inner marginal fibres of the circular group run to the bone in this region : a group of these below reach the upper ramus of ischium as the “ ischio-capsular band.”

The posterior surface of the acetabular mass is covered by Pyriformis, and may give origin to some fibres of Gluteus minimus deep to this : the sciatic nerves, etc., and nerve to Quadratus femoris pass down on it. The thin floor of the acetabulum is occasionally, like the thinnest part of the iliac fossa, found to be perforated, and the hole is then closed by membrane.

 

Fig. 106. — To illustrate the formation of the ligamentum teres. In its early stage the ilium (il) and ischium (is) are alone concerned in the articulation, the synovial lining passing off them on to the capsule which is attached round their surfaces. The pubis is covered by these fibres and has no articular area. In the next stage the covering fibres are destroyed and the pubis has acquired an articular surface (p). This extends, and the front part of the original ischial capsule is caught, so to speak, between the extending surface and the ischium; these fibres persist and remain attached to the ischial region, but on their surface the synovial cavity has extended, as shown in the last diagram, and has joined the older cavity below as well, passing between the femur and the lower portion of the attached capsule. Thus a synovial funnel is formed, wider below where it includes the attachment of the fibres and narrowed at its femoral end, where it is fastened to the fovea.

 

Fig. 107. — Postero-external aspect of right os innominatum. The curved lines are somewhat diagrammatically drawn : for account see the text. Some of the fibres of the great sciatic ligament run on to the surface of the bone round x, and give origin here to part of G. maximus. The position of the sacrum and great ligament is indicated, with the origin of the muscle from it. A is the surface below the inferior curved line, covered by G. min. ; B, the area covered by Pyriformis, with the great sciatic nerve interposed ; C, covered by Obturator internus and Gemelli, which lie between the nerve and the bone, but have the' nerve to Quadratus between them and the bone. The muscles mentioned are practically in a continuous curved plane, so that the areas A, B, and C make a convex surface, continuously curved and smooth, round the acetabulum ; the muscles pass to the raised trochanter, so do not mould the bone by pressure. The lower aspect of the tuber ischii, below the facets for the hamstring muscles, shows two sloping surfaces, of which one looks outwards and gives origin to fibres of Adductor magnus (ischio-condylar portion), while the other looks inwards (D) and is covered by fibrofatty tissue which is continuous round the great sacro-sciatic ligament with that of the ischio-rectal fossa : in this tissue is a badly-defined bursa which lies under the tuberosity in sitting, the hamstrings and Adductor moving to the outer side of the prominence when the limbs are bent for that purpose.

 

Quote p. 142-143

 

The Ligamentum teres is a weak synovial attachment of the head of the femur to the cotyloid fossa and transverse ligament: it is (p. 127) the remains of the primitive capsule isolated by the secondary taking up of the pubic surface into the joint, and has little mechanical value, but carries some small vessels and nerves to the head of the bone.

 

Fig. 118.Upper end of right femur. The epiphysial line for the great trochanter is marked in green round its base. The “retinacula of Weitbrecht,” fibres running back toward the head under the synovial membrane, are shown only where they are congregated into their three main groups; they are derived from the transverse capsular fibres, and the upper one obtains many fibres from Pyriformis (see Fig. 117). 1. Anterior aspect. Observe that the Gluteus minimus is attached only to the outer ridge of the trochanter, but its tendon is continuous below with an aponeurotic sheet, the ilio-trochanteric band, which covers the bursa in front and reaches the bone internal to it. The upper part of the origin of Crureus is mainly tendinous. The extension of the cartilage of the head on to the neck is shown at x ; this lies under the ilio-femoral band or, if the opening for the sub-Psoas bursa is large, under the tendon of the Psoas. 2. From the outer side. The oblique insertion of Gluteus medius is continuous below and in front with that of Gluteus minimus, and frequently with that of Pyriformis above and behind ; it divides this aspect of the trochanter into two areas, one, C, in front and above, under cover of medius and therefore bevelled off in the direction of that muscle, the other. A, below and behind, covered by Gluteus maximus and therefore moulded by that muscle so that it is more vertically directed and curved from before backwards. The surface C carries a bursa? but A has only occasionally an extension of the bursa situated below in relation with it. B, surface covered by Vastus externus and more or less flattened by it. Crureus fuses with V. externus at a lower level. 3. Posterior aspect. D, surface covered by Quadratus femoris; deep to this muscle the Obturator externus lies against the bone, moulding the back and lower part of the neck in the area F as it passes to the digital fossa. 4. From the inner side. Observe the pointed area between the spiral line and pectineal line which is occupied by iliacus. E, inner surface, covered by Vastus internus but not affording origin to it; the Crureus does not transgress the inner border.

 


External links

Frazer JES. Anatomy of the Human Skeleton. 2nd ed., London: J. & A. Churchill, 1920. archive.org , wellcomecollection.org


Authors & Affiliations

John Ernest Sullivan Frazer (1870-1946) was a British surgeon, anatomist, and professor of anatomy at the University of London. livesonline.rcseng.ac.uk


Keywords

ligamentum capitis femoris, ligamentum teres, ligament of head of femur, anatomy, embryology, development, attachment


                                                                     

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