670 HUMAN ANATOMY. 



tuberosity of the ischium, runs horizontally outward, and crosses the middle of the 

 lower edge of the gluteus maximus, part of which — the inner — is therefore above it 

 and part — the outer — below it. In flexion of the hip the gluteus maximus is flattened 

 and the skin stretched over it, and hence this fold is more or less completely effaced. 

 As flexion is an almost constant early symptom of hip-joint disease (page 381), and 

 is usually associated with atrophy of the muscles moving the joint, the obliteration of 

 the gluteo-femoral crease, characteristic of this disease, can readily be understood. 



In women, on account of the thickness of the supragluteal layer of fat, the gluteo- 

 femoral crease is longer and deeper than in men. 



The various bony points of this region have been described (pages 345, 349), as 

 have the different lines and measurements employed in the diagnosis of fractures of 

 the neck of the femur and of dislocation (pages 362, 364, 367). 



2. The Thigh. — (a) Atiterior crural , region. The hip passes insensibly in 

 front and below into the region of the thigh. The inguinal furrow, a valuable land- 

 mark, separates the surface of the abdomen from that of the thigh (page 1774). It 

 indicates the line of Poupart's ligament, which may be felt, in the absence of muth 

 subcutaneous fat, from the iliac spine to the pubic spine, more easily over its inner 

 half, and still more easily if the thigh is in extension, abduction, and outward rotation. 



The ligament is relaxed by flexion, adduction, and inward rotation of the thigh, 

 and with it, to some extent, the deep fasciae of the thigh and abdomen ; therefore 

 that position is the one most favorable to reduction of either inguinal or femoral 

 hernia by taxis (pages 1770, 1774). 



Below this a second furrow — " Holden's line" — is sometimes seen with the thigh 

 in slight flexion, beginning at the scroto-femoral angle and becoming less distinct until 

 it is lost at or over the supratrochanteric space. It runs across the front of the cap- 

 sule of the hip-joint and is lost in the presence of synovitis of that joint. It is often 

 indistinct, and in some subjects cannot be made out at all (Treves). 



On the line of this furrow, and just external to a vertical line drawn through the 

 middle of Poupart's ligament, the head of the femur can sometim*fes be made palpable 

 by extension and rotation of the thigh, but this is rarely possible in fat or muscular 

 persons. 



The depression or flattening of Scarpa's triangle (page 639) can usually be seen. 

 The tendon of origin of the adductor longus — made prominent by abduction — and 

 the upper portion of the sartorius, emphasized by flexion and outward rotation of the 

 thigh with the knee bent, mark its inner and outer borders respectively. The sar- 

 torius, continued downward, becomes flattened an(5 is lost in the rounded fulness on 

 the inner side of the knee. Just internal to a line bisecting the triangle the femoral 

 artery may be felt and its pulsations sometimes seen. A very trifling depression is 

 occasionally present near the inner angle at the base of the triangle, and then indi- 

 cates the position of the saphenous opening (page 635), the centre of which is from 

 one to one and a half inches below and the same distance external to the pubic spine, 

 which is on a transverse line drawn through the upper margin of the greater trochan- 

 ter. From the apex of the triangle the shallow groove, extending towards the inner 

 side of the knee, marks the course of the sartorius and the interval between the 'quad- 

 riceps extensor and the adductors. To the outer side of the triangle the rectus can be 

 seen, showing below the anterior superior spine in the interval between the sartorius 

 and the tensor fasciae latae ; it runs down the front of the thigh, giving it its convex 

 fulness, and narrowing to its ending in the flattened quadriceps tendon, the edges of 

 which stand out when the leg is strongly extended on the thigh. The obliteration 

 of Scarpa's triangle, in full extension of the thigh, is due to the thrusting forward 

 of the overlying tissues by the neck and the upper end of the shaft of the femur. 



To the inner side of Scarpa's triangle, below and posteriorly to the adductor 

 longus, the other adductors and the gracilis give the rounded outline to the' inner side 

 of the upper thigh. Near the knee, when the leg is flexed, the tendon of insertion of 

 the adductor magnus can be plainly felt between the sartorius and vastus internus. 

 The latter muscle stands out along the lower half of the thigh and is still more promi- 

 nent near the knee, where it becomes superficial between the rectus and the sartorius. 



On the outer side the vastus externus gives the thigh its broad, slightly convex 

 surface, down the centre of which there is sometimes a slight vertical groove indi- 



