THE REGION OF THE HIP. 



FIG. 77. The subinguinal region with the vessels and lymphatic glands lying upon the deep fascia. 

 FIG. 78. The topography of the deep gluteal region. 



with the joint. Pus occasionally escapes from the joint by this route and passes beneath the 

 psoas muscle; an iliac abscess may pass beneath Poupart's ligament and enter the joint at this 

 point, and with particular ease, of course, when there has been a previous communication between 

 the bursa and the joint. 



As the femoral vessels and the anterior crural nerve are almost immediately in front of the 

 joint, they are frequently involved by articular affections (for example, by pressure from an 

 anterior dislocation); posteriorly the sciatic nerve (see page 161) is also occasionally indicated 

 in affections of the joint. 



The muscles, the vessels, and the nerves pass beneath Poupart's ligament from the iliac 

 fossa and reach the anterior surface of the thigh according to a typical topographic arrangement 

 (Fig. 76). This is particularly of practical importance toward the symphysis on account of 

 the occasional occurrence of femoral hernia, which escapes beneath Poupart's ligament, in 

 contradistinction to the inguinal variety, which passes out from the abdomen above this structure 

 through the external abdominal ring (see page 124). The ilio psoas muscle passes to the thigh 

 beneath the outer portion of Poupart's ligament, accompanied by the anterior crural nerve, 

 and covered by the iliac fascia (Fig. 76). The fascia is adherent to the ligament as it passes 

 beneath this structure, but it subsequently follows the surface of the muscle inward and is 

 attached to the iliopectineal eminence. From this point the fascia passes over the pelvic margin 

 to the thigh and, as the iliopectineal fascia, follows the iliopsoas and pectineus muscles behind 

 the femoral vessels and forms the so-called deep layer (pubic portion) of the fascia lata. To 

 the inner side of the iliopsoas muscle and its fascia there is left a second space beneath Poupart's 

 ligament, which extends toward the symphysis as far as Gimbernat's ligament (i. e., the broad 

 reflection of the inner end of Poupart's ligament to the crest of the pubis). This space gives 

 passage to the great vessels and is called the lacuna -vasorum; the space beneath Poupart's liga- 

 ment to the outer side of the iliopectineal fascia is known as the lacuna musculorum. The 

 femoral artery is situated in the outer portion of the lacuna vasorum, and the femoral vein is 

 placed immediately to the inner side of the artery, but it does not extend to the concave margin 

 of Gimbernat's ligament. There is left between the vein and the margin of the ligament a 

 small space which is filled by connective tissue and frequently also by a lymphatic gland (the 

 gland of Rosenmuller). This space is the femoral ring (annulus femoralis), the place of exit 

 of femoral hernia which pushes the peritoneum before it, passes beneath Poupart's ligament, 

 and appears beneath the skin at the saphenous opening. 



The saphenous opening (fossa ovalis) in the fascia lata, bounded externally by the margo 

 falciformis (Fig. 77), is closed by a thin fascia which is called the cribriform fascia. The internal 

 saphenous vein, the varicose dilatations of which are more or less troublesome, runs up the 

 inner side of the thigh somewhat posterior to the margin of the sartorius muscle, and passes 

 through the saphenous opening to empty into the femoral vein. The cribriform fascia, or the 

 adjacent portions of the fascia lata, are perforated by the superficial epigastric and superficial 

 circumflex iliac vessels and also by smaller arterial branches on their way to supply the numerous 



