Bony pelvis : lecture notes for viva examination

 

Bony pelvis

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Anatomical points

1.      Anterior superior iliac spine and upper part of pubic symphysis lie in the same coronal  plane

2.      Pubis symphysis lies horizontally

3.      The tip of the coccyx and upper part of pubic symphysis lie in same horizontal plane

|Formation of pelvis : two hip bones, sacrum and coccyx

Joint of pelvis :

Pubic symphysis : secondary cartilaginous joint

Sacroiliac joint : plane variety of synovial joint

Divisions of pelvis : greater(false pelvis )  and lesser pelvis (true )

Why greater pelvis is known as false pelvis: it has no body boundary in front

Why lesser pelvis is known as true pelvis: it has complete body boundary

Q. Trace the pelvic inlet and outlet

Q. Content of pelvis in male and female

Q: How pelvic outlet is covered  in living body ?

In front by urogenital diaphragm and behind pelvic diaphragm

Q: What is urogenital diaphragm :

 It is formed by deep transverse perinea muscle and sphincter urethrae muscle

Q: What is pelvic diaphragm

It is formed by levator ani and coccygeus muscle

Show the Diameters of pelvis :

Pelvic inlet

	Antero-posterior diameter	Transverse diameter:	Oblique diameter:
Pelvic inlet	Measured between sacral promontory and symphysis pubis Upper border of pubic symphysis:  True or Anatomical conjugate Middle of pubic symphysis:  Obstetric conjugate (most important) Lower border of pubic symphysis: Diagonal conjugate	Maximum transverse diameter	Measured between the sacro-iliac (SI) joint and opposite ilio-pubic eminence
Pelvic cavity	Middle of S3 vertebra to the middle of the back of pubic symphysis	Widest distance across the lateral bony wall of the pelvic cavity	From the lower end of sacroiliac joint to the center of the opposite obturator membrane
Pelvic outlet	Antero-posterior diameters: From the lower border of symphysis pubis to – Anatomical: tip of coccyx Obstetric: tip of sacrum	Transverse diameters: diameter: between 2 ischial tuberosities	From the junction of the ischiopubic ramus to the middle of the opposite sacrotuberous ligament

 

Diameter of female pelvis

	Antero-posterior diameter	Transverse diameter:	Oblique diameter:
Pelvic inlet	11 cm	13	12
Pelvic cavity	12	12	12
Pelvic outlet	13	11	12

Diameter of different conjugate of  female   :

·         True or Anatomical conjugate: 11 cm

·         Obstetric conjugate (most important): 0.5 cm shorter than the true conjugate

·         Diagonal conjugate: 11.5 cm

Classification of pelvis

1.      Gynecoid (50%) – normal female pelvis

2.      Anthropoid (25%) – direct occipito-posterior position is most common in anthropoid pelvis

3.      Android (20%) – male type (face to pubes delivery, persistent occipito-posterior position, deep transverse arrest/non-rotation, dystocia-dystrophica syndrome are most common in android pelvis)

4.      Platypelloid (5%)

Difference between male and female pelvis

 

Topic	Male	Female
Shape of pelvic inlet	Heart shape	Oval
shape of pelvic caviy	conical and long ( long section of a cone)	short and cylindrical ( short section of a cylinder)
sub pubic angle	less , 55-60 degree	More, about  90 degree
ischial spine	inverted	everted
sacrum	longer and narrower	shorter and wider
Obturator foramen	Larger and oval and abruptly curve	Smaller and triangular, gradually curved

 

 

Base of the skull anatomical points, parts

 Base of the skull:

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Define skull:  cranium with mandible is known as skull

Parts of the skull :

Base of the skull and

Cranial vault

Ossification :

base of the skull (intracartilaginous ossification) &

cranial vault : intramembranous ossification

Anatomical points:

1.       infraorbital margin and and upper border of external auditory meatus lies in same horizontal line , this line is known as  Frankfort  line

2.       orbital cavity directed anteriorly

3.       foramen magnum lies horizontally and directed  inferiorly

Show different view of skull :

·         norma verticalis : viewed from above

·         norma frontalis  from front

·         norma basalis from below

·         norma occipitalis from behind

·         norma lateralis from sides

Identification and definition of: bregma, lambda , asterion, pterior  

** pterion: it is the meeting point of 4 bones frontal , squamous part of temporal bone, parietal bone and greater wings of sphenoid clinical important : deep to this point branches of middle meningeal vessels are present . this vessel torn in accident , barr hole operation done here

Cranial fossa : three in number anterior, middle and posterior

Learn Boundary and content of each cranial fossa :

Development of skeletal system : summary

 

Development of skeletal system 

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The skeletal system develops from paraxial, somatic layer of lateral plate mesoderm and neural crest

 Neural crest: develops facial skeleton, and most of the vault of cranium and prechordal part of  base of the skull (area of base of the skull just rostral to the rostral half of the sella turcica)

Paraxial mesoderm: parietal bone, occipital bone, petrous part of temporal bone, vertebrae, ribs

Somatic layer of lateral plate mesoderm: develops all  bones of upper and lower limb

Clinical questions : scalp Why do scalp wounds bleed profusely?

 To help you recall the layers of the scalp, which are Skin, Dense Connective Tissue, Epicranial Aponeurosis, Loose Areolar Connective Tissue, and Periosteum, try using the acronym "SCALP."

The skin is home to many sebaceous glands and hair follicles, making it a typical location for sebaceous cysts.
The layer that joins the epidermis to the epicranial aponeurosis is called dense connective tissue. It has a dense innervation and vascularization.
The blood vessels in the layer have a strong bond with the connective tissue. This prevents them from completely constricting in the event of a laceration, which increases the risk of excessive bleeding on the scalp.
The tendon-like structure known as the epicranial apontoneurosis joins the frontalis and occipitalis muscles.

Why do scalp wounds bleed profusely?

The second layer of the scalp is composed of fibrous tissue, which adheres to the blood vessel walls on the outside. The scalp has a large blood supply. As fibrous tissue forces the blood vessel wall outward when it is cut or sliced, the blood vessels are unable to retract, resulting in extensive bleeding.

Why is the fourth layer of scalp, or loose areolar tissue, referred to as the "dangerous layer of scalp"?

Because it contains the emissary veins that connect the scalp's veins to the intracranial dural venous sinuses, the subaponeurotic loose areolar connective tissue layer is referred to as a dangerous layer of the scalp because it tends to collect blood and pus. This means that infection from this layer can easily spread along the emissary veins and enter the intracranial venous sinuses.

Difference between skeletal muscle and cardiac muscle : easy notes for written examination

 Skeletal muscles are voluntary muscle which attached with skeleton of body , helps in movement .

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Cardiac muscle pump blood and form myocardium of heart 

Topics	Skeletal	Cardiac
Shape and size	long and cylindrical	Short, cylindrical
Location	skeleton muscle (muscle attached with skeleton)	Heart, SVC, IVC
Connective tissue components	Epimysium (cover whole muscle) ,  perimysium (cover individual muscle bundle)   Endomysium (cover individual muscle cell)	Endomysium
Branching	Absent	Present
Striation	Present	Present
Nucleus	Multinucleated & Peripherally placed	Single centerally placed
Cell to cell junctions	None	Intercalated disks containing fasciae adherents macula adherens gap junctions
Special features	Well-developed sER and T- tubules	Intercalated disks
Functions	Voluntary	Involuntary
Regeneration	Limited	None

Difference between primary and secondary cartilaginous joint

 Difference between primary and secondary cartilaginous joint 

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Cartilaginous joints : articular surfaces of two bones are connected by cartilage. 

Theses joints are formed by only hyaline cartilage or both hyaline  and fibrocartilage. 

Primary cartilaginous joint	Secondary cartilaginous joint
It is also known as Synchondroses	it is also known as symphysis
articular surfaces are connected by hyaline cartilage	articular surfaces are covered by thin plates of hyaline cartilage which is separated by fibro-cartilage.
It is a temporary joint	It is a permanent joint
Hyaline cartilage of joint is converted into bone	thin hyaline cartilage and fibrocartilage are not converted into bone
they are not located in the median plane	they are usually located in the  median plane
It allows no movement	It allows little movement
they make very strong joint Exmple: costochondral joint	they make relatively strong joint example : menubriosternal join

The midline anterior abdominal incision

 

The midline anterior abdominal incision

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Extension: from the xiphoid to the pubic symphysis.

Advantage or use of this incision

1.       Bloodless

2.      No muscle cut

3.      No nerves divided

4.      Less complication during incision

5.      Rapid and easy closer possible

6.      When wide exposure is required

Disadvantage / need to be careful

The upper region of the midline contains the ligamentum teres and the falciform ligament; therefore, the peritoneum should open just to the left or right of the midline to prevent damage to this structure.

Following structure cut during this incision

1.       Skin,

2.      Subcutaneous fascia and  fatty tissue,

3.        Linea alba, is formed by the union of aponeuroses (of the muscles of the anterior abdominal wall) that collectively make up the rectus sheath.

4.       Transverse fascia

5.      Extra-peritoneal fat and

6.      Peritoneum