166 



EXTREMITY. 



nally; secondly, with the external condyle of 

 the femur; thirdly, with the malleolus exter- 

 nus, because these relations are constantly va- 

 luable guides, as well in the diagnosis as in 

 the reduction, of the luxations of the femur and 

 of the fractures of the neck or shaft of the 

 bone." 



The external surface of the great trochanter 

 is convex and rough, and the tendon of the 

 glutceus maximus muscle covers it in the recent 

 condition ; this surface is terminated below by 

 a projecting line, into which is inserted the 

 upper extremity of the vastus externus muscle. 

 The internal surface is of much less extent : it 

 is placed at right angles with the superior sur- 

 face of the neck of the bone, and at its posterior 

 part it is excavated so as to form a deep pit or 

 depression, the digital cavity orjbssa trochante- 

 rica, into which are inserted the tendon of the 

 pyriformis, the gemelli, and the obturatores 

 internus and externus. The anterior edge is 

 thick and irregular; the glutcei medius and 

 minimus are inserted into it, the former into 

 its inferior, the latter into its superior part. 

 Superiorly the trochanter forms a thin edge, 

 more or less pointed, into the interior half of 

 which the glutceus minimus is inserted, and 

 into its posterior or pointed portion the glutceus 

 medius; it may in general be observed, that 

 the size of this pointed part of the superior 

 edge of the great trochanter is proportionate to 

 the developement of the glutoeus medius mus- 

 cle. The posterior edge is convex and thick, 

 and gives attachment to the quadratus femoris 

 muscle. 



At the inferior angle of the base of the cervix 

 femoris, and on the internal and posterior part, 

 we notice a short conical process, trochanter 

 minor, (processus interior femor is,) attached 

 to the bone by its base, its apex directed 

 downwards, inwards, and backwards, smooth 

 on its whole surface. This process affords 

 insertion to the tendon of the psoas and iliacus 

 muscles. 



In the male adult, theaxisof the head and neck 

 of the femur passes downwards, outwards, and 

 slightly backwards, and forms an obtuse angle 

 with the shaft, an angle of about 135 degrees. 

 In the female this angle is somewhat smaller, and 

 approaches more nearly to a right angle, which 

 contributes with the greater lateral dimensions 

 of the pelvis, to increase the distance of the 

 trochanters of opposite sides from each other, 

 and to cause that projection of these processes 

 which forms a peculiarity of the female form. 

 In early age, when the neck of the femur is 

 imperfectly developed, the angle between the 

 neck and shaft is not denned ; in the earliest 

 condition the connexion of the head and shaft 

 very much resembles the permanent condition 

 of the corresponding parts in the humerus ; as 

 the neck becomes developed, the angle is ren- 

 dered apparent, at first, however, little removed 

 from a right angle, but subsequently it in- 

 creases up to the adult period ; after that time 

 we often find that the neck of the bone dimi- 

 nishes in its dimensions, and the angle is con- 

 sequently altered, so as to approximate to a 

 right angle. 



The following may be given as the mean 

 measurements of the different parts of the neck 

 of the femur. In the centre it measures about 

 one inch, its posterior surface about fifteen 

 lines, its inferior edge about twenty lines, and 

 its superior about eleven lines ; its vertical 

 diameter, in its most contracted part, is about 

 seventeen lines, and its antero-posterior about 

 ten. 



The shaft of the femur forms a slight curve 

 from above downwards, convex anteriorly and 

 concave posteriorly, the excavation thus formed 

 behind being filled up by the powerful muscles" 

 on the back of the thigh. It likewise presents 

 the appearance as if it had been twisted, like 

 that which we have noticed in the humerus, 

 the inferior extremity being twisted inwards, 

 the superior in the contrary direction. Cru- 

 veilhier remarks, that this curvature of torsion 

 is in relation with the disposition of the femoral 

 artery, which in its spiral course passes from 

 the anterior to the posterior surface of the bone. 



In the greater part of its extent the shaft of 

 the femur is prismatic ; at the superior extre- 

 mity it is expanded laterally and flattened ; at 

 the inferior it is likewise very considerably ex- 

 panded. 



The anterior surface of the shaft is smooth 

 and rounded ; at the upper part it is a little 

 rough: this surface is covered completely by 

 the triceps extensor muscle. The posterior 

 surface is divided along the middle into two, 

 which are inclined, the one forwards and in- 

 wards, the other forwards and outwards ; the 

 external surface is covered by the vastus exter- 

 nus, the internal by the vastus internus. In 

 the middle, separating these two surfaces, is a 

 rough ridge, linea aspera, which occupies two- 

 fifths of the shaft of the bone about its middle, 

 but is bifurcated above and below. Superiorly 

 the bifurcation takes place about the termina- 

 tion of the superior fifth ; two lines proceed, 

 the external, rough and prominent, to the great 

 trochanter ; the internal, rather indistinct, to the 

 lesser trochanter. The external line gives in- 

 sertion to the vastus externus, the adductor 

 magnus, and the glutceus maximus ; the pecti- 

 naeus and the vastus internus are inserted into 

 the internal line. Inferiorly, the bifurcation 

 takes place at a point corresponding to the 

 commencement of the two inferior fifths ; each 

 line proceeds down to the corresponding con- 

 dyle, and a triangular space is thus enclosed, 

 the base of which is formed by the posterior 

 extremities of the condyles, and the apex is at 

 the point of bifurcation of the linea aspera. 

 This space, which presents a smooth surface, 

 slightly concave in both the vertical and trans- 

 verse directions, forms the floor of the popliteal 

 region. The external line, from the inferior 

 bifurcation, is more prominent than the inter- 

 nal, and gives insertion to the vastus externus 

 and to the short head of the biceps. The in- 

 ternal is very faint superiorly where the femoral 

 artery passes over it, and inferiorly the vastus 

 internus and the adductor magnus are inserted 

 into it. 



The nutritious foramen of the femur is found 

 either upon, or on one side of, the liuea aspera. 



