1182 



SURGICAL Ayn TOPOGRAPHICAL A^,^ATOMr 



THE KNEE 



Bony landmarks. — The patella, the condyles, the tuberosities of the tibia, the 

 tulieTcle (.)f the til)ia, the head of the tibula. 



The patella. — The limb l^eing sui)ported in the straight position, and the 

 extensor muscles relaxed, the numerous longitudinal stria.' or sulci on the anterior 

 surface of this bone can be detected. In these are embedded tendinous l)undles of 

 the rectus, so as to give firmer leverage. The fact that these fibres, thus tied down, 



Fig. 748. — The Gluteal Kegion, with the Gluteal, Sciatic, and Pudic Akteeiks. 



(From a dissection by W. J. Walsham iu St. Bartholomew's Hospital Museum.) 



The inferior gluteal branch of the sciatic artery has been drawn inwards over the tuber ischii with the 

 reflected origin of the gluteus niaximus muscle. 



Gluteus mediUB, turned up 



INFERIOR GLUTEAL NERVE 

 Gluteus maximus, cut 

 Internal circumjiei artery 

 Obturator externus 



Insertion of gluteus medius 



External circumflez artery 



Gluteus minimus 



Muscular branches of sciatic artery 

 Deep branch of gluteal artery 



SUPERIOR GLUTEAL SER\E 



Pyriformis perforated by peroneal 

 portion of sciatic nerve 



Cut edge of gluteus maximus 



Insertion of 

 gluteus maximus 



First perfnratiiKj iirlery 



Quadratus" femoris 



J'lidir a I ten/ and nerve 

 Sciatic artery 



Branch of internal circumflex rirteri/ 

 Obturator internus with the two gemelli 



Pemi-tendinosus 

 Semi-membranosus 



LESSER SCIATIC NERVE 

 Arteria comes neri'i ischiatici 

 PO PL I TEA L PORTION OF GREA T SCI A TIC NER VE 

 LONG PUDENDAL NERVE 

 PERONEAL PORTION OF GREA T SCIA TIC NER VE 



are liable to fold in between the ends of the boiic after fracture, is a ready explana- 

 tion of the difficulty of ensuring bony union here (Macewen). The j^atella is 

 separated from the tiljia by a pad of fat and a deep bursa, save at its insertion. It 

 has the following relation to the femur in different ])Ositions: — (1) In extension, 

 the patella rises over the condyles, and in full extension only the lower third of 

 its articular surface rests upon that of the condyles; its upper two-thirds lies upon 

 the bed of fat Avhich covers the lower and front part of the femur. (2) In extreme 

 flexion, as the prominent anterior surface of the condyles affords leverage to the 



