 Good day everybody. This is Dr. Sanjay Sanyal, Professor, Department Chair. This is going to be the first part of the demonstration of the femur. So this in front of you is the left femur. So we can see the whole femur in totality and now I'm going to zoom in towards the upper part. So this is the head of the femur. This is the neck of the femur. This is the greater trochanter. This is the lesser trochanter. This is the anterior view so therefore there is a very faint line which connects the greater to the lesser trochanter that is called the intertrochanter line. Similarly in the posterior aspect there will be a ridge and that will be called the intertrochanter crest which I will show you when I turn the femur. Let's come back to the head. In life the head is covered by halan cartilage and this is the head which forms the hip joint and it articulates with the acetabulum, especially the lunate part of the acetabulum which also is lined by halan cartilage. Now where my finger is located there is a depression here. This is called the fovea of the head of femur. This fovea gives attachment to a ligament which is called the ligament of the head of femur and through that ligament passes a very small artery which is called the artery to the head of femur which is the branch of the operator artery. Coming back if you take a close look at the neck we find that the neck is not smooth but it's got multiple parallel vertical ridges and grooves. These ridges and grooves are produced by folds of synovial membrane which are called retinaculum and through each fold of synovial membrane runs a small artery called the retinacular artery which is the branches of the medial circumflex femoral artery from the profundum femoris. These retinacular arteries are the ones which supply the bulk of the head of the femur and the neck of the femur. The artery which I mentioned earlier, the artery to the head of femur is not a major supply of the head. It supplies only the epithesis of the head of the femur. That brings us to a very important clinical correlation. Fracture of the neck of femur is not very uncommon especially in elderly ladies who are suffering from postmenopausal osteoporosis. In fact, quite often we see elderly ladies brought to the hospital say that they fell down and they were found lying on the pavement. Initially we used to think that they fell down and they broke their neck of femur but now it is believed that because of postmenopausal osteoporosis they had fractured the neck of femur spontaneously and then they fell down. This is the coronal MRI of the left hip to show fracture of the neck of the femur and this is the blade x-ray of the neck of the femur to show intertrogatric fracture of the neck. Fracture of the neck of the femur can be classified as subcapital fracture just under the head, trans cervical fracture, intertrogatric fracture. It is a complex classification. Once the neck of femur fractures, the arterial supply to the head gets jeopardized and therefore the head of the femur undergoes avascular necrosis and it will never unite with the rest of the femur. Therefore the only solution will be to do excision of the head of the femur and replacement arthroblasty. If only the head is damaged, we can do partial replacement. If the astroblore fossa is also degenerated, then we have to do total hip replacement arthroblasty. This is the x-ray of the right hip to show a total hip replacement arthroblasty where both the components have been replaced and this is a picture to show the components of the hip replacement both the astroblore component and the femoral component. The capsule of the hip joint encloses the head and it goes and it gets attached to the intertrogatric line in front. But posteriorly it is not attached to the intertrogatric crest. There is a gap and through that a fold of synable membrane comes out. So that is about the head and the neck of the femur and its blood supply. Let's continue down. We can see various colors here. Those are the sides of the origin of the insertion of muscles which I shall tell you in another video. To continue down, this is the shaft of the femur and we can see that the shaft of the femur is pretty structure-less because it gives attachment to big big muscles. This particular muscle that we see here which is taking origin is the vastus interverus. So therefore there is nothing much to report on the anterior surface. This whole thing is covered by the vastus intermerias. To come further down, now we are coming to the lower part of the femur and we see these are the two femoral condyles. This is the medial femoral condyle and this is the lateral femoral condyle. Whichever direction is the head, that is the medial side. So therefore this is the left femur as I said. This is the medial femoral condyle, this is the lateral. And in between, this is the shallow groove anteriorly. This is the intercondyler notch and it's smooth here and this is the one which articulates with the patella and that forms a femoral patella articulation. So therefore it is covered by highland cartilage in life. Now what I'm going to do, I'm going to turn the femur. Now I've turned the femur and we are seeing the pustula aspect. And we can see that this is the greater trochanter and this is the lesser trochanter. And instead of a line, there is a ridge here and that is called the intertrochanteric crest. As I mentioned, the intertrochanteric crest the pustula capsule of the hip joint is not attached here. Instead it stops short somewhere here and there's a gap through which the sonnable membrane protrudes out. On the middle of the intertrochanteric crest we see this elevation here, this is the quadrate tubercle. This gives attachment to the quadratus femoris muscle which is the deep muscle of the gluteal region. And here also we can see of the pustula aspect we can see that the neck of the femur of the pustula aspect shows multiple ridges and grooves. These are all grooves and ridges formed by the retinocular folds with a retinocular artery. The same thing which we saw on the anterior aspect. Now I'm bringing the camera down to the middle portion and we can see this is the shaft of the femur and the shaft of the femur is a ridge here which is called the linia aspera which gives attachment to many muscles, both origin and insertion which if I were to trace the linia aspera we find that it has got a lateral lip and it's got a medial lip and each of them give attachment to various muscles and these two lips lower down they split into two ridges a lateral supracondyler ridge and a medial supracondyler ridge which end in correspondingly the lateral condyler of the femur and the medial condyler of the femur condyl means knuckle in Latin in between the smooth surface this is the intercondyler fossa and this part forms part of the knee joint which is covered by the capsule of the knee joint this is the pubicule surface of the femur which forms part of the flow of the pubicule fossa let's come back to the linia aspera if we trace the linia aspera up we find that the linia aspera above also splits into lateral and medial line the medial line continues up and it becomes a spiral line and further up it becomes a pectinial line which gives attachment to the pectinous muscle the lateral one it continues up and we find that there is another elevation here this is called the gluteal tuberosity which gives attachment to the deep one-fourth of the gluteus maximus the lateral lip of the linia aspera gives attachment to the vestus lateralis and it also gives attachment to the short head of the biceps femoris the medial lip of the linia aspera we can see it is getting insertion to all the adductor muscles it gives attachment to pectinous muscle in the pectinial line adductor brevis adductor longus adductor magnus the nutrient artery of the femur is very small therefore we cannot see it here but if you were to locate it you will find that the direction of the flow of nutrient artery will be away from the knee so in this we have a mnemonic in the form of a poem towards the elbow eye flow away from the knee eye flee therefore they go away from the knee let's mention a few clinical correlations pertaining to the femur if there is a fracture of the shaft of the femur invariably the femur will get displaced because the femur gives attachment to so many powerful muscles of the thigh that it cannot be held in place it will not only get displaced but there will be overriding of the fragments therefore femur fractures are very difficult to treat and they cannot be treated by the closed method they have to be treated by open reduction and internal fixation after initial traction when there is a femur fracture there is considerable blood loss the blood loss can be anything from 1.5 to 2.5 liters and all of these will be collected deep to the fascia letter the patient can do vasogenic shock the next point to be remembered about the femur is I am going to turn the femur again and now we are seeing the anterior aspect of the femur again the weight varying of the femur is through the head vertically down and that is achieved by the ilium which is overhanging the head of the femur but the shaft of the femur is a little away from the head so therefore there is a thick ridges of bone inside you go from the head like this to the shaft and those thick ridges of bone are called the calcar femoral so therefore they transmit the force of the weight of the body across the calcar femoral to the shaft the next thing you notice is an angulation between the head the greater trochanter this line and a vertical line through the femur this is called the angle of inclination in normal person this angle is 115 to 140 degrees average is 126 degrees if the angle becomes less than 115 it is called coxa vera which is usually seen in advancing age and if the angle is more than 140 it is called coxa valga which is seen in infancy and childhood and there is another angle between long axis of the femur which goes right up to here and the vertical line that is called the q angle is also called the angle of declination and that is approximately 9 degrees if the angle becomes more than 17 degrees then it is called genu valga and if it becomes less than 9 degrees it is called genu vara that is more pertinent to the knee which is bow leg so that is another functional aspect of the femur and the weight bearing transmission these are all the things which I want to tell you in this particular video more will follow when I am going to mention all the muscle attachments thank you very much for watching if you have any questions or comments please put them in the comment section below please like and subscribe have a nice day