Femur, femur, represents the largest and thickest of all long tubular bones. Like all similar bones, it is a long lever of movement and has a diaphysis, metaphyses, epiphyses and apophyses according to its development.

The upper (proximal) end of the femur bears a round articular head, caput femoris (epiphysis), slightly down from the middle on the head there is a small rough pit, fovea capitits femoris, the place of attachment of the ligament of the femoral head. The head is connected to the rest of the bone through the neck, collum femoris, which stands to the axis of the body of the femur at an obtuse angle (about 114-153°); in women, depending on the greater width of their pelvis, this angle approaches a straight line. At the junction of the neck and the body of the femur, two bony tubercles, called trochanters (apophyses), protrude.

The greater trochanter, trochanter major, represents the upper end of the body of the femur. On its medial surface, facing the neck, there is a fossa, fossa trochanterica.

The lesser trochanter, trochanter minor, is located at the lower edge of the neck on the medial side and somewhat posteriorly. Both trochanters are connected to each other on the posterior side of the femur by an obliquely running ridge, crista intertrochanterica, and on the anterior surface - linea intertrochanterica. All these formations - trochanters, ridge, line and fossa are caused by muscle attachment.

The body of the femur is slightly curved anteriorly and has a trihedral-rounded shape; on its back side there is a trace of attachment of the thigh muscles, linea aspera (rough), consisting of two lips - the lateral one, labium laterale, and the medial one, labium mediale. Both lips in their proximal part have traces of attachment of the homonymous muscles, the lateral lip is tuberositas glutea, the medial lip is linea pectinea. At the bottom, the lips, diverging from each other, limit a smooth triangular area, facies poplitea, on the back of the thigh. The lower (distal) thickened end of the femur forms two rounded condyles that wrap back, condylus medialis and condylus lateralis (epiphysis), of which the medial one protrudes more downward than the lateral one. However, despite such inequality in the size of both condyles, the latter are located at the same level, since in its natural position the femur stands obliquely, and its lower end is located closer to the midline than the upper. On the anterior side, the articular surfaces of the condyles pass into each other, forming a small concavity in the sagittal direction, facies patellaris, since the patella is adjacent to it with its posterior side during extension in the knee joint. On the posterior and inferior sides, the condyles are separated by a deep intercondylar fossa, fossa intercondylar. On the side of each condyle above its articular surface there is a rough tubercle called epicondylus medialis in the medial condyle and epicondylus lateralis in the lateral condyle.

Ossification. On x-rays of the proximal end of the femur of a newborn, only the femoral diaphysis is visible, since the epiphysis, metaphysis and apophyses (trochanter major et minor) are still in the cartilaginous phase of development. The X-ray picture of further changes is determined by the appearance of a ossification point in the head of the femur (epiphysis) in the 1st year, in the greater trochanter (apophysis) in the 3-4th year and in the lesser trochanter in the 9-14th year. Fusion occurs in the reverse order between the ages of 17 and 19 years.

Anatomically, the head of the femur is held by the annular glenoid fossa. It is considered the largest in the body, and therefore it has a complex structure and performs a large number of motor functions. It is not easy for a person far from medicine to understand this, but to understand the causes and characteristics of the course of diseases of the femur, it is necessary.

Anatomy of the femur

The femur plays an important role in the human body, as it is the largest tubular bone tissue in the skeleton. It, like other tubular bones, has two ends and a body. It is connected to the pelvis by the head, which ends in the upper proximal section.

The transition of the neck to the bone body ends with tubercles - trochanters. The bony body ends with the greater trochanter. There is a small depression on its medial surface. On the posterior side of the lower edge of the neck is the lesser trochanter. The greater one is connected to it by the intertrochanteric ridge, which runs along the back of the bone.

Functions of the hip

The entire lower limb is very important for a person, as it takes part in all movements of the body. In addition, the structure of the femur helps a person to be in an upright position, while bearing all static loads. Thanks to the femur, a person has the ability to walk, run, jump, play sports and perform more strenuous activities.

Major lesions of the femur

The main and most common injuries and lesions of the femur are: fracture of the greater trochanter of the femur, fracture of the lesser trochanter, bursitis, trochanteritis, tendinosis.

Types of trochanteric fractures

Trochanteric fractures are common in older people who have been diagnosed with a common disease such as osteoporosis. The most common trochanteric fractures are:

1. Pertrochanteric simple and splintered. With such a fracture, the direction of the bone fracture line coincides with the one that connects the greater and lesser trochanters.
2. Intertrochanteric. Such a fracture is characterized by the fact that the line of damage crosses the line that connects the greater and lesser trochanters.

Such injuries can be impacted or non-impacted, here is the clinical picture.

Thanks to muscle traction, in simple fractures the fragments come together. This facilitates bone healing and repositioning. Fractures with multiple fragments heal less well and require stronger fixation.

Intertrochanteric fractures are characterized by the fact that the work of the muscles around them does not contribute to healing in any way, but vice versa. This explains the importance of rigid fixation.

Greater trochanter fracture

This type of damage to the femur occurs directly when force is applied directly to the area of ​​the greater trochanter. In children, this is usually apophysiolysis with displacement of the diaphysis. In this case, 2 or 3 fragments of the greater trochanter may be completely crushed.

The most common lesions of the femur in older people are trochanteric and femoral neck fractures. With a fracture of the greater trochanter, the displacement of the bone can be directed upward, backward or forward. This is due to the fact that bone strength decreases over the years, and ordinary loads on the musculoskeletal system can become traumatic.

With a trochanteric fracture, the patient feels a sharp pain in the affected area, and upon palpation, slight mobility of the joint can be detected. In addition, a small crunching sound is characteristic of a fresh fracture. When a fracture occurs, the functional part of the hip is impaired, especially with regard to its abduction. If the greater trochanteric bone is fractured, you may be able to put weight on the affected leg, but you will feel a limp.

A patient with such a fracture can freely bend and straighten his leg at the knee joint, but attempts to turn the leg cause the patient severe pain. If he can lift his extended leg up, this means that there is no fracture of the femoral neck. It is worth noting that it is impossible to move the leg to the side if the femur is fractured due to the sharp pain in the affected area.

Greater trochanteric tendinosis

This disease is a fairly common pathology. Typical for people who overload the hip joint. This category mainly includes athletes.

With tendinosis in the greater trochanter, the inflammatory process begins in the ligaments and tendons, subsequently spreading to the tissue. The process begins at the point where the bone connects to the ligament. If a person does not pay attention to this, continuing to load the joint, the inflammation becomes chronic.

Provoking factors include the following:

1. Joint injury.
2. Failures in metabolic processes.
3. Congenital dysplasia of the joints, which affects not only the articular surfaces, but also the entire ligamentous apparatus.
4. Disturbances in the functioning of the endocrine system.
5. Aging of the body, during which the structure of bones and ligaments changes.
6. Systematic loads associated with monotony of work.
7. Spread of infection into surrounding tissues.
8. Inflammatory processes in the joints.

Clinical picture:

1. Pain on palpation and movement of the limb.
2. As you move, the bones begin to crunch.
3. The skin at the site of the lesion changes color and becomes red.
4. Local increase in temperature at the site of injury.
5. The joint cannot perform its direct functions.

Inflammation

Bursitis of the trochanteric bursa is inflammation between the fascia lata and the greater trochanter. It is located on the outside of the femur in the upper part. At the same time, fluid collects in the bag, its walls expand, and pain appears. This disease is very dangerous due to its complications, including complete immobilization of the joint.

Pain that occurs at the protrusion of the femur of the greater trochanter is the most basic sign of the onset of pathology. While walking and with any impact on the joint, the pain intensifies. At a later stage, the inflammatory process caused by bursitis begins to spread to the lower part of the thigh, thereby causing lameness in the patient. Even if this does not reduce the load on the affected limb, then after a while pain may begin to appear at rest.

Diagnostics

To diagnose a fracture of the greater trochanter of the femur, an x-ray is taken; if necessary, the doctor decides to send the patient for a computed tomography scan. Tendinosis is diagnosed through palpation, radiography, magnetic resonance imaging and ultrasound examination of the affected area.

Methods for treating fractures

When the greater trochanter of the femur is fractured, the patient is usually given a circular plaster cast in abduction position for 3 weeks. After the prescribed period, the plaster is removed, and the patient is prescribed a course of massage on the affected area. During this period, the patient can move with the help of crutches, since such a load does not cause him any discomfort or pain.

But in some cases, doctors have to resort to open reduction using bone holders specially designed for such procedures, that is, bone fragments are compared with each other, which ensures better fusion. This procedure is performed if, when the leg is abducted, it is not possible to set the bone fragments.

Tendinosis therapy

Treatment of this pathology is carried out using complex measures. Depending on the location of the lesion and the stage of the disease, the doctor prescribes the optimal therapy. To relieve pain, the patient is prescribed painkillers and ice compresses, which must be applied to the affected area.

Using elastic bandages or bandages, the affected joint is limited in movement. In addition, physiotherapeutic procedures are used to treat tendinosis. Magnetic therapy, laser therapy, ultrasound, for example, have a good effect; applications of therapeutic mud and baths with mineral salts also help. As recovery progresses, the patient should begin a course of exercise therapy. Exercises help improve joint mobility, elasticity and muscle strength.

Surgery for tendinosis is a last resort treatment for this disease and is used in very rare cases. Doctors try to manage with conservative methods of therapy.

What to do with bursitis?

Treatment of bursitis should begin with simple procedures. Very rarely, this disease requires surgical intervention. Patients under thirty years of age are recommended to reduce the load on the affected joint and undergo a course of rehabilitation therapy, which includes exercises to stretch the muscles of the thighs and buttocks.

Treatment of inflammation of the greater trochanter of the femur involves the use of anti-inflammatory drugs. With the help of such drugs, swelling of the affected joint and pain are effectively relieved. The use of cold, ultrasound, heating and UHF helps to get rid of pain and relieve swelling.

One of the most convenient methods of exposure at home is the use of heat or cold. It is important to remember that cold is used immediately after an injury, and heat is used for inflammatory processes that occur in a chronic form. An experienced physiotherapist will be able to give useful recommendations, using which you can completely restore all motor functions of the joint. If fluid accumulates in the trochanteric bursa, the patient is recommended to undergo a puncture in order to pump out all the water and send it to the laboratory for analysis.

During this procedure, a small dose of steroid hormones, such as cortisone, is injected into the trochanteric bursa, but this can only be done if the patient does not have any infectious diseases. The hormonal drug quickly relieves inflammation. The effect of the procedure can last for 6-8 months.

A timely visit to a doctor will help to cure all existing disorders in the femur in a short time. If any of the pathologies in a given part of the human body becomes chronic, then the pain syndrome stops only for a while.

Skeleton of the free lower limb (skeleton membri inferioris liberi) consists of the femur, two tibia bones and foot bones. In addition, there is another small (sesamoid) bone adjacent to the femur - the patella.

Femur

Femur, femur, represents the largest and thickest of all long tubular bones. Like all similar bones, it is a long lever of movement and has a diaphysis, metaphyses, epiphyses and apophyses according to its development.

The upper (proximal) end of the femur bears the round articular head, caput femoris (epiphysis), slightly down from the middle there is a small rough pit on the head, fovea captits femoris, - the place of attachment of the ligament of the femoral head.

The head is connected to the rest of the bone through the neck, collum femoris, which stands at an obtuse angle to the axis of the femur body (about 114-153°); in women, depending on the greater width of their pelvis, this angle approaches a straight line. At the junction of the neck and the body of the femur, two bony tubercles, called trochanters (apophyses), protrude.

Greater skewer, trochanter major, represents the upper end of the body of the femur. On its medial surface, facing the neck, there is a fossa, fossa trochanterica.

Lesser trochanter, trochanter minor, placed at the lower edge of the neck on the medial side and slightly posteriorly. Both trochanters are connected to each other on the back of the femur by an oblique ridge, crista intertrochanterica, and on the front surface - linea intertrochanterica. All these formations - trochanters, ridge, line and fossa are caused by muscle attachment.

The body of the femur is slightly curved anteriorly and has a trihedral-rounded shape; on its back side there is a trace of the attachment of the thigh muscles, linea aspera (rough), consisting of two lips - lateral, labium laterale, and medial, labium mediale.
Both lips in their proximal part have traces of attachment of the so-called muscles, the lateral lip - tuberositas glutea, medial - linea pectinea. At the bottom, the lips, diverging from each other, limit a smooth triangular area on the back of the thigh, facies poplitea.

The lower (distal) thickened end of the femur forms two rounded condyles that wrap back, condylus medialis and condylus lateralis(epiphysis), of which the medial one protrudes more downward than the lateral one.

However, despite such inequality in the size of both condyles, the latter are located at the same level, since in its natural position the femur stands obliquely, and its lower end is located closer to the midline than the upper.

On the anterior side, the articular surfaces of the condyles pass into each other, forming a small concavity in the sagittal direction, facies patellaris, since it is adjacent to its back side patella when extending the knee joint. On the posterior and inferior sides the condyles are separated by a deep intercondylar fossa, fossa intercondylar.

On the side of each condyle above its articular surface there is a rough tubercle called epicondylus medialis at the medial condyle and epicondylus lateralis at the lateral one.

Ossification. On x-rays of the proximal end of the femur of a newborn, only the femoral diaphysis is visible, since the epiphysis, metaphysis and apophyses (trochanter major et minor) are still in the cartilaginous phase of development.

The femur is the longest and thickest tubular bone in the human body, located in the proximal parts of the lower extremities. Bone is one of the most important structural elements of the musculoskeletal system; it ensures the movement of the human body in space. In this article, we will take a closer look at the anatomy of the femur and its main functions, and talk about its possible injuries.

The femur, together with muscles, ligaments, as well as femoral vessels, nerves and other tissues, forms a large structural unit of the lower limb - the thigh. At the top in front the thigh is limited by the inguinal ligament, at the back by the fold of the buttock, at the bottom it ends 5 cm above the patella. The femur has slightly different boundaries: at the top it ends with a transition to the connection with the pelvis - the hip joint, at the bottom, together with the tibia and patella, it forms the knee joint. To better understand where the bone in question is located in our body, just study the image (highlighted in red):

On the outside, the femur is covered with connective tissue - 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).
• Metaphyses (areas of bone between the epiphysis and diaphysis).
• Apophyses (muscle attachment site).

Structure of the femur.

The upper end of the bone ends in a head, which participates together with the pelvis in the formation of the joint. The head has a rough pit, which serves as a place where the ligaments are attached. The head is connected to the body of the bone by a neck, which forms an angle in relation to the diaphysis of the bone. Normally in men it should be stupid. In women, due to their reproductive function and physiologically wide pelvis, this angle is close to 90 degrees.

In the place where the neck is attached to the body of the femur, apophyses are located - 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. Inward from it there is a formation - the trochanteric fossa. The second is on the medial or inner side of the bone and is more posterior.

The distal or inferior end of the bone is formed by two condyles. They are thickenings of the bone, have a rounded shape, wrapping back. The surfaces of the condyles serve as articular surfaces of the knee joint; from above they are connected into 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 within the knee joint at approximately the same level, since the femur occupies an oblique position.

Functional role

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

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

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

Possible damage

When the femur is injured, its integrity is disrupted, which is otherwise called a fracture. Depending on which part of the bone the fracture occurred, they are distinguished: proximal, diaphyseal, distal. These possible types of injury are distinguished by the mechanism of injury, so they should be considered separately.

Depending on their location in relation to the hip joint, proximal bone fractures 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 due to the development of necrosis. Due to the fact that the bone forms an angle that is sharper in women, this injury is 2 times less common in men. More often, a fracture in this place occurs in older people. The main reason for the loss of integrity is a blow received as a result of a fall on a slippery surface (ice, slippery floor, etc.). In this case, the leg turns outward and shortens somewhat, 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 femoral shaft are relatively rare because great force is required to break the integrity. Such injuries occur when falling from a height or a car accident. Since the force acting on the leg is high, the fracture is usually associated with a soft tissue injury. In this case, the shortening of the limb can reach 8–10 cm, since the bone fragments are significantly retracted by the muscles attached to them.

Fractures of the lower part of the bone occur as a result of falling on the knee or a strong blow. It is also possible that the tibia is forcibly deviated 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 onto your feet. With this injury, shortening of the limb does not occur. The predominant symptoms are severe pain in the knee joint, swelling, and possible deviation of the lower leg to the side.

The femur is one of the important structural elements of the skeleton, serving 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 layman should have at least a superficial understanding of the structure of our body. After all, this is not only useful, but also very interesting information!

The femur is the largest bone of the human skeleton, directly involved in the process of human movement when walking or running. It has a saber shape and normally withstands the mechanical effects of blows, falls or compression. Damage to the hip bone is extremely dangerous and can lead to complete immobility in old age.

The main purpose of this bone is to support the weight of the human body and strengthen the muscles involved in walking, running and maintaining the human body in an upright position while moving in space.

In this regard, it has its own unique anatomy. The structure of the femur is quite simple. It consists of a hollow cylindrical structure that expands downward, and the leg muscles are attached to its rear surface, along a special rough line.

The head of the bone is located on the proximal epiphysis and has an articular surface that serves to articulate the bone with the acetabulum. There is a hole located exactly in the middle of the head. It is connected to the body of the bone by a neck, which has an inclination of its axis of 130° relative to the body.

At the junction of the neck and the body of the bone element there are two tubercles. They are called the greater and lesser trochanters. The first bump can be easily felt under the skin, as it projects laterally. His small brother is located behind and from the inside. The trochanters are connected to each other anteriorly by the intertrochanteric line, while posteriorly this function is performed by a pronounced intertrochanteric ridge. The trochanteric fossa is located near the greater trochanter in the area of ​​the femoral neck. Such a complex structure with a large number of depressions and protrusions is necessary for attaching the leg muscles to the bone element.

The lower end of the bone is wider than the upper, and it smoothly passes into two condyles, between which is placed an intercondylar fossa, easily viewed from the front. The function of the femoral condyles is to articulate with the tibia and patella.

It is worth knowing that this element of the femur has a surface radius that decreases posteriorly and is shaped like a spiral. The lateral surfaces of the bone element have protrusions in the form of epicondyles. Their purpose is to attach ligaments. These parts of the body can also be felt quite easily through the skin, both from the inside and the outside.

The hip bone, despite the fact that it can withstand significant loads, often breaks. This is due to the fact that it has the greatest length in the human body, therefore, with a direct blow or a fall on a hard object, it is almost 100% likely to fracture.

The anatomy of the femur is such that its fractures are usually always accompanied by a violation of its anatomical integrity, and the injury is always severe, accompanied by severe blood loss and painful shock. For sick or elderly people, such damage can be fatal.

The femur, depending on the location of the fracture, can have three types of injury:

• diaphysis injury;
• damage to the upper bone end;
• injuries of the distal metaepiphysis of the bone.

Diagnosing fractures is usually not difficult, since they are visible to the naked eye, although the full clinical picture depends solely on the specific form of a particular fracture. In most cases, the patient cannot lift the heel off the floor, and feels pain in the hip joint.

The pain intensifies if the patient tries to make passive and active movements. It is especially aggravated when the fracture is open and a piece of bone comes out through the muscles and skin. In this case, any movement is strictly prohibited.

The X-ray machine allows you to establish:

• type and nature of the fracture;
• its heaviness;
• the degree of damage to the soft tissue surrounding the bone.

An accurate diagnosis of a fracture is only possible with the help of an X-ray machine, while the femur may not be completely broken, but only have a crack. Bone cracks are just as dangerous as fractures, as they threaten to disrupt its shape and form calluses, making it difficult for a person to walk.

The main method of treating fractures of this bone is its traction. In case of transverse fractures, a Kirschner wire is used for skeletal traction. It is worth remembering that applying a splint and plaster cast in case of a fracture of the tibia will not give the desired effect, so you need to start the traction procedure as quickly as possible.

The fact is that the sooner the reposition of bone fragments and bone traction begins, the better the effect can be achieved. If the incorrect position of bone fragments is established too late, it becomes difficult or even impossible to carry out full treatment.

Sometimes bone fragments are returned to their place simultaneously under general anesthesia. This operation is performed when large debris has been displaced. This usually refers to fractures of the lower third of the femur. After “straightening,” the patient’s leg is fixed at the knee and a plaster cast is applied to it.

Healing of fractures of the described types usually occurs by 35-42 days. In this case, the duration of treatment can vary quite significantly depending on the nature of a particular fracture, the gender and age of the patient, and his condition. However, it is impossible to focus only on these terms, since the degree of recovery of the patient can only be determined by a clinical study.

This is how it can determine how strong the callus formed at the fracture site is. If it is not completely formed, treatment can be continued, but the pin will be removed from the leg in any case within a month.

The traction procedure for a fracture of the femur must be monitored by x-rays, and “x-raying” must be carried out at least once a week. If the bone heals incorrectly, then it is worth making adjustments using special medical equipment.

Proper treatment will result in an almost perfect leg. Moreover, if a limb shortening of more than two centimeters is recorded, then measures will have to be taken, since in this case the gait may not be restored, and the internal organs and spine will be infringed. Therefore, the patient should monitor his condition very carefully and promptly inform the attending physician about its changes.

After treatment is completed, the patient is allowed to put weight on the affected leg no earlier than two to three weeks. To reduce this period, physical therapy and warm baths are used.

If conservative treatment methods do not bring results, the patient may be indicated for surgical intervention. This may be improper bone fusion, the appearance of suppuration processes, or serious deformations of the femur.

Managing the rehabilitation period

After completion of treatment, the rehabilitation period begins. During this time, the limb should fully restore all its functions and the patient should be completely cured. During rehabilitation, the patient must adhere to certain rules.

You should not lie down for a long time, and at the end of the treatment period you must get out of bed as quickly as possible. The sooner the patient gets up, the lower his risk of complications. If the pain cannot be tolerated, you should take a painkiller, but you should not abuse this medicine, as it has a very bad effect on the heart and liver.

Physiotherapeutic procedures are usually prescribed to speed up the recovery process. In this case, the patient is allowed to use a cane, walker or crutches. It’s worth taking care of yourself at this time and not putting unnecessary strain on your sore leg.

Diet plays a special role during the rehabilitation period. It should be balanced and contain fruits, vegetables and foods rich in calcium. You should try to avoid constipation and other stomach upsets, as this can reduce the patient’s mobility and negatively affect his rehabilitation. It is best not to leave him alone during this period, as relatives can prevent the occurrence of new injuries as a result of a fall of a person suffering from a fracture of the femur.