The the posterior abdominal wall . Vastus lateralis

The linea aspera represents the posterior cortical
thickening of the femoral diaphysis which working as a muscular
attachement  and buttressing the
concavity of the femoral shaft at the middle portion of the shaft , the femur
has smooth medial, lateral and posterior borders . In the proximal and distal
portion of the femur , the linea aspera widens to create an additional
posterior surface .

 

Muscle attachements :-

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The subtrochanteric region of the femur is completely
covered by mascular envelops. The muscles of the thigh are arranged in three
compartements separated from each other by inter mascular septa .

Figure (2) muscle attachement of the anterior
aspect of the femur (   )

 

The anterior compartement of the thigh :-

Is formed by the Sartorius and the four ,quadriceps
femors muscles (rectus femoris, vastus lateralis, vastus medialis, and vastus
intermedius). Which is all are supplied by the femoral nerve . In addition the
terminal ends of the muscles, psoas major and iliacus pass into the upper portion
of the anterior compartement from its site of origin at the posterior abdominal
wall .

Vastus lateralis musclehas its linear attachement from
the base of the greater trochanter to the proximal end of the gluteal
tuberosity and along the lateral margin of the proximal half of the lateral
edge of the linea aspera

Figure
(3) anterior compartement of the thigh muscles

Figure (4) Showing the vastus lateralis muscle

 

The posterior compartement of the thigh :-

It consists of three muscles (semitendinousus ,
semimembranousuds and the biceps femoris muscle). all the three muscles are called
the hamstring muscles. And all are supplied by the sciatic nerve .

Figure (5) showing muscle
attachement of the posterior compartement of the thigh

 

Figure (6) showing muscles of the posterior
compartement of the thigh

 

The medial compartement of the thigh :-

It consists of six muscles (gracilis, pectineus
,adductor longus, adductor brevis, adductor magnus and obturator externus) all
theses muscles are supplied by the femoral nerve except the pectineus muscle
and part of the adductor magnus muscle which are supplied by the obturator nrve
. adductor magnus is attached to the linea aspera and its aponeurosis is
attached to the proximal part of the medial supracondylar ridge and its remaining
fibers fuse to form alarge tendon which are attached to the adductor tubercle ,
with an aponeurotic expansion is attached to the distal part of the medial
supracondylar ridge .figure (7) .

Figure (7) muscles of the medial compartement of the
thigh

 

Pectineus and adductor brevis are attached to the
posterior surface of the femur between the gluteal tuberosity and the spiral
line ,the pectineal attachement is a rough line from the base of the lesser
trochanter to the linea aspera . Adductor brevis attachement is lateral to the
pectineus and behind this to the proximal part of the linea aspera , medial to
the adductor magnus .adductor longus, intermascular septa and the short head of
the biceps femoris are
attached to the linea aspera .

The proximal shaft of the femur can be exposed easily
through the lateral approach with the dissection of the vastus lateralis and
ligation of the perforators vessels .

The muscular attachements which are surrounding the
proximal femur are the most common cause of the deformity following the
subtrochanteric fracture of the femur .hence as a result of these strong
deforming forces which are making the reduction is difficult to be achieved in
young adult patients . and shortening of the femur resulting from the spastic
tone of the group of muscles which are spanning the proximal femur  including the quadriceps and the hamstring
muscles .

For the subtrochanteric fracture the proximal segment
is flexed & abducted and externally rotated by hip abductors, the external
rotators and the iliopsoas muscles. The adductors typically acting to medialize
the distal component of the femur. The subtrochanteric fracture that are
associated with fracture of the lesser trochanter the deformity may be less as
the flexion and the external rotation of the iliopsoas will be neutralized.

Figure (8) Showing the deforming forces which
are acting on the proximal and distal segment of the femur.

 

Vascular anatomy of the proximal femur:-

The blood supply to the shaft of the femur is from the
femoral artery and its main branch the profunda femoris artery by nutrient
vessels in combination with numerous periosteal vessels figure (9) .the
nutrient artery entering the region of the linea aspera in the proximal third
of the femur .hence the linea aspera should not be stripped out of its muscular
attachement in order to maintain the blood supply to the shaft of the femur.

The situation of the medial femoral circumflex vessels
which is mostly related to the surgical exposure of the hip especialy when
we  considering its   location in close proximity to the nail
entery point .

Figure (9) blood supply and circulation of the hip and
the upper thigh (  )

 

The blood supply of the femoral head is originating
from an arterial ring around the neck , just outside the attachement of the
fibrous capsule and there is continuation by the medial and lateral circumflex
arteries with minimal contributions from the superior and inferior gluteal
arteries. also from this ring , ascending cervical branches piercing the
capsule to enter the neck beneath the reflected synovial membrane .all these
vessels becoming the retinacular arteries and form a synovial intra –articular
ring.

Small medial epiphyseal supply, which is considered of
much importance in the early childhood, it reaching the head a long the
ligamentum teres. The regions of the trochanteric femur and the subtrochanteric
shaft of femur both are supplied by the trochanteric and the cruciate arterial
anastomosis .at the most distal area of the shaft of femur ,nutrient foramina
directed proximally which are mostly founded in the linea aspera varying mostly
in site & number . one of these nutrient arteries usually present near its
proximal end and the second one usually present near its distal end. The main
nutrient artery usually orginated from the second perforator . The Periosteal
vessels  originating from  the perforators and from the profunda femoris
artery, and running in circumferential pattern.

 

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