Anatomy and Physiology

The Femur
The femur is the only bone in the thigh. It is classed as a long bone, and is in fact the longest
bone in the body. The main function of the femur is to transmit forces from the tibia to the hip
joint.
It acts as the place of origin and attachment of many muscles and ligaments so we shall split it
into three areas; proximal, shaft and distal.
Proximal
The proximal area of the femur forms the hip joint with the pelvis. It consists of a head and neck,
and two bony processes called trochanters. There are also two bony ridges connecting the two
trochanters
Head Has a smooth surface with a depression on the medial surface this is for the attachment
of the ligament of the head. At the hip joint, it articulates with the acetabulum of the pelvis.
Neck Connects the head of the femur with the shaft. It is cylindrical, projecting in a superior
and medial direction this angle of projection allows for an increased range of movement at the
hip joint
Greater trochanter this is a projection of bone that originates from the anterior shaft, just
lateral to where the neck joins. It is angled superiorly and posteriorly, and can be found on both
the anterior and posterior sides of the femur. It is the site of attachment of the abductor and
lateral rotator muscles of the leg
Lesser trochanter much smaller than the greater trochanter. It projects from the posteromedial
side of the side, just inferior to the neck-shaft junction. The psoas major and iliacus muscles
attach here.
Intertrochanteric line a ridge of bone that runs in a inferomedial direction on the anterior
surface of the femur, connecting the two trochanters together. The iliofemoral ligament attaches
here a very strong ligament of the hip joint. After it passes the lesser trochanter on the posterior
surface, it is known as the pectineal line.
Intertrochanteric crest similar to the intertrochanteric line, this is a ridge of bone that
connects the two trochanters together. It is located on the posterior surface of the femur. There is
a rounded tubercle on its superior half, this is called the quadrate tubercle, which is where the
quadratus femoris attaches.

Image 1: Anterior Proximal Femur Image 2: Posterior Proximal Femur







The Shaft

The shaft descends in a slight medial direction. This brings the
knees closer to the bodys center of gravity, increasing stability.
On the posterior surface of the femoral shaft, there are roughened
ridges of bone, these are called the linea aspera (Latin for rough
line)
Proximally, the medial border of the linea aspera becomes the
pectineal line. The lateral border becomes the gluteal tuberosity,
where the gluteus maximus attaches.
Distally, the linea aspera widens and forms the floor of the
popliteal fossa, the medial and lateral borders form the the medial
and lateral supracondylar lines. The medial supracondyle line
stops at the adductor tubercle, where the adductor magnus
attaches.



Image: Posterior surface of the femoral shaft, showing the linea aspera.

Distal
The distal end is characterised by the presence of the medial and lateral condyles, which
articulate with the tibia and patella, forming the knee joint.
Medial and lateral condyles rounded areas at the end of the femur. The posterior and inferior
surfaces articulate with the tibia and menisci of the knee, while the anterior surface articulates
with the patella.
Medial and lateral epicondyles bony elevations on the non articular areas of the condyles.
They are the area of attachment of some muscles and the collateral ligaments of the knee joint.
Intercondylar fossa A depression found on the posterior surface of the femur, it lies in
between the two condyles. It contains two facets for attachment of internal knee ligaments.
Facet for attachment of the posterior cruciate ligament found on the medial wall of the
intercondylar fossa, it is a large rounded flat face, where the posterior crucitate ligament of the
knee attaches.
Facet for attachment of anterior cruciate ligament - found on the lateral wall of the
intercondylar fossa, it is smaller than the facet on the medial wall, and is where the anterior
cruciate ligament of the knee attaches.


Image 1: Anterior Surface of the Distal Femur Image 2: Posterior Surface of the Distal Femur



Pathophysiology:

Predisposing Factors:
Age: Most common among elderly
Trauma
Comorbidity
Malnutrition
Neurologic Problems
Obesity
Slower Reflexes
Precipitating Factors:
Fall
Osteoporosis
Functional disability
Impaired vision and balance
Vehicular accident for younger age
Damage to the integrity of the bone
Damage to the blood supply to an
entire bone.
Severe circulatory compromise
Avascular (ischemic ) necrosis may result
Clinical Manifestation:

Bleeding
Open wound-
Active
Bleeding
Close wound-
Hematoma
Cx. Shock from
Blood loss
Possibility of
infection for open
wound
Pressure on the nerve
endings (Fluid pooling) and
blood vessel
pain, swelling
and tenderness
Paleness, Loss
of pulse,
Numbness,
Tingling,
paralysis
Guarding
behavior
Immobilization
Weakness
Cx. Possibility of
Fat embolism
and thrombus
dislodge ( from
injury response
of the body) to
the brain and
lungs and
possibility of
necrosis (due to
compromised
circulation)
Destroyed muscle
and bone tissue
Spasm, Crepitus,
Loss of function

Shortening of the
affected leg
(contracture)
Deformity
Inability to bear
weight
Cx. Bed Sore
(immobility)
Possiblity of
failure to heal (
Non- union)
Permanent
deformity

Emotional
response
Feeling of rush,
Anxiety, Nervousness,
fear of unknown or
further injury or
permanent deformity
Cx. Partial PTSD w/c is
characterized by flash
back, phobia, fear of
resistance to medical
procedure, blaming of
self, anxious and
feeling of losing
control