Chapter 2

HIP BONE
Textbook of
Human Anatomy
Volume 3: Lower Limb
Author: Dr Yogesh Sontakke,
JIPMER, Pondicherry
©CBS Publishers & Distributors Pvt Ltd, New Delhi
 As per:
Competency based Undergraduate
curriculum
AN14.1:
• Bone: Lower limb
• Identify given bone, side, and important
features, and keep in anatomical position

Medical Council of India, Competency based Undergraduate curriculum for the Indian Medical Graduate,
2018. Vol. 1; pg 1-80.
Human Anatomy/Yogesh Sontakke 2
 INTRODUCTIO
N
• Each lower limb – supported with 31 bones
Are as follows
• Pelvic girdle
• Hip bone 1
• Bone of thigh
• Femur 1
• Knee cap
• Patella 1
 INTRODUCTIO
• Bones of leg
N
• Tibia 1
• Fibula 1
• Bones of foot
• Tarsals 7
• Metatarsals 5
• Phalanges 14
• Hip bone (pelvic girdle) connects lower limb with
axial skeleton
• chapter discusses features of hip bone
 HIP
BONE
• Also called os coxae or os
innominatum
• Large irregular-shaped flat bone
Parts of Hip Bone
• Consists of three parts
• Ilium – upper expanded part
• Ischium
• Pubis
• Has upper and lower expanded
parts and middle constricted part
– presents large cup-shaped
 HIP
BONE
• Lower expanded part has
large aperture, obturator
foramen
• Pubis lies anteromedially to
obturator foramen
• Ischium lies posterolateral to
obturator foramen
• Lower end of ischium –
thick, and forms ischial
tuberosity
 Anatomical Position and Side
 Hold
determination
bone in such way that
o Large cup-shaped acetabulum lies
laterally and looks vertically downward
o Flat expanded ilium projects upward
o Obturator foramen lies below acetabulum
o Thin pubis lies anteromedial to obturator
foramen and thick ischium lies
posterolateral to foramen
 Anatomical Position and Side
 Tilt
determination
bone in such way that
o Anterior superior iliac spine and pubic
tubercle lie in same coronal plane
o Note: Acetabulum will determine side to
which bone belongs; for example, for right
hip bone, acetabulum lies on right
 ILIUM
• Forms upper flat and
expanded plate of bone
projects above acetabulum

Parts of Ilium
• Consists of following parts
• Two ends – upper (iliac
crest) and lower ends
• Three borders – anterior,
posterior, and medial
surfaces
 ILIUM
Parts of Ilium
• Three surfaces – external
(gluteal), internal (iliac
fossa), and sacropelvic
borders
Features of Ilium
Ends of ilium
• Has two ends
• Upper end called iliac
crest
• Lower end
 Iliac
crest
Upper thickened curved border of
ilium
Curvatures
 Vertically – convex upward
 Anteroposteriorly – concave
medially in anterior two-thirds
and convex medially in posterior
one-third
Ends of iliac crest
 Anterior superior iliac spine
(ASIS)
 Iliac
Anterior superiorcrest
iliac spine
(ASIS)
Attachments
• Gives attachment to
• Lateral end of inguinal
ligament
• Sartorius muscle (origin)
• Extends onto upper part
of notch below anterior
superior iliac spine
 Iliac
crest
Posterior superior iliac spine
(PSIS)
 Posterior end of iliac crest
 Less prominent than
anterior superior iliac spine

Attachment
• Gives attachment to
sacrotuberous ligament
Inguinal ligament
• Lower margin of external oblique aponeurosis (part
of external oblique muscle of anterior abdominal
wall)
• Extends between pubic tubercle and anterior
superior iliac spine
Some Interesting Facts
• Iliac crest can be felt in living at lower limit of trunk
• Highest point of iliac crest lies posteriorly at level of
interval between L3 and L4 vertebrae
 Iliac
Segments of iliac crest
crest
Divided into following
• Long ventral segment (anterior two-thirds)
• Short dorsal segment (posterior one-third)
Ventral segment of iliac crest
- Has outer-lip, inner-lip, and intermediate area
Tubercle of iliac crest
• Outer lip of iliac crest has outward bony projection, 5
cm behind anterior superior iliac spine
• Bony projection – called tubercle of iliac crest
 Iliac
Ventral segment ofcrest
iliac crest
Attachments
• Outer lip
• Tensor fascia latae - originates in front of tubercle
of iliac crest
• External oblique - muscle of anterior abdominal
wall inserts in anterior two-thirds
• Latissimus dorsi - originates just behind highest
point of iliac crest
• Iliotibial tract - attaches with tubercle of iliac crest
Human Anatomy/Yogesh Sontakke 21
 Iliac
Ventral segment ofcrest
iliac crest
Attachments
• Intermediate area
 Internal oblique - muscle of abdomen originates
from intermediate area of iliac crest
• Inner lip
 Transverse abdominis - originates from anterior
two-thirds of inner lip
 Quadratus lumborum - originates from posterior
one-third of inner lip
 Iliac
Dorsal segment of iliac crest
crest
- Divided into outer and inner sloping areas by ridge
Attachments
• Outer sloping area: origin of gluteus maximus
• Inner sloping area: origin of erector spinae
Erector spinae
• Group of muscles called sacrospinalis
• Fibers of these muscles connect sacrum, iliac crest,
and spines of lower vertebrae to spines of cervical
and higher thoracic vertebrae
 Clinical
 Hematopoiesis Integration
 Iliac crest – site of hematopoiesis
even in adults
 Bone marrow aspiration
 Procedure of taking out sample of
cells for microscopic examination
 Useful for diagnosis of anemia,
leukemia, and many other diseases
 Posterior part of iliac crest –
commonly used for bone marrow
aspiration
 Clinical
 Integration
Bone marrow donation
 For bone marrow
transplantation, cells can be
collected from donor from
posterior part of iliac crest
 Cells can be used to treat
aplastic anemia patients, post-
chemotherapy cases, and so
on
Lower end of ilium Iliac
 Smaller crest
 Fuses with ischium and pubis
at acetabulum
 Forms upper two-fifths of
acetabulum
Borders of ilium
Anterior border of ilium
 Extent
 Extends from anterior
superior iliac spine to
acetabulum
 Borders of
Anterior border of ilium
 Features
ilium
 Notch: Upper part of
anterior border shows notch
 Anterior inferior iliac spine
(AIIS)
 Small forward projection of
lower part of anterior border
Attachments
 Straight head of rectus
femoris - Originates from
upper part of AIIS
 Iliofemoral ligament -
 Borders of
Posterior border of ilium
ilium
 Extent
 Extends from posterior superior
iliac spine to posterior border of
ischium

Features
 Posterior inferior iliac spine (PIIS)
 Bony prominence, few
centimeters below the posterior
superior iliac spine
 Greater sciatic notch
 Deep notch below posterior
inferior iliac spine
 Borders of
Posterior border of iliumilium
 Greater sciatic notch
 Below greater sciatic notch, there –ischial
spine

Attachments
 Sacrotuberous ligament - Attached to
posterior border between PSIS and PIIS
 Piriformis muscle –Few fibers of
piriformis originate from upper border of
greater sciatic notch
 Some interesting
facts
 Greater sciatic foramen
 Greater sciatic notch – converted into greater sciatic
foramen by sacrospinous and sacrotuberous ligaments
 Structures passing through greater sciatic foramen
 Some interesting
Medial Borderfacts
of Ilium
 Extent
 Extends on pelvic (inner)
surface on the ilium from
the iliac crest to iliopubic
eminence
 Separates iliac fossa from
sacropelvic surface of
ilium
 Arcuate line
 Lower part of medial
border forms rounded
 Surfaces of
ilium
Has three surfaces
• Gluteal surface
• Iliac surface
• Sacropelvic surface
Iliac surface (iliac fossa) of ilium
 Shallow, concave, smooth fossa on internal surface
of ilium
 Iliac fossa is bounded
• Superiorly – by iliac crest
• Anteriorly – anterior border
• Posteriorly – medial border
 Iliac fossa forms lateral wall of false pelvis
 Surfaces of
ilium
Pelvis = hip bones + sacrum + coccyx
• True pelvis
• Lower part of pelvic cavity lies below arcuate line
or pelvic inlet
• False pelvis
• Upper broad part of pelvis lies above pelvic inlet
• Pelvic inlet – bounded by pubic symphysis,
iliopectineal line, and sacrum
Attachments
 Iliacus muscle originates from upper two-thirds
of iliac fossa
 Surfaces of
Gluteal surface ofilium
ilium
 Outer surface of ilium
 Divided into four areas by three gluteal lines

Gluteal lines
 Posterior gluteal line
 Extends from point 5 cm in front of posterior superior
iliac spine to point in front of posterior inferior iliac spine
 Shortest gluteal line
 Surfaces of
Gluteal surface ofilium
ilium
Gluteal lines
 Anterior (or middle) gluteal line
 Extends from greater sciatic notch to iliac crest, in front
of iliac tubercle
 Inferior gluteal line
 Extends from upper part of anterior inferior iliac spine to
lower part of greater sciatic notch
 Surfaces of
Gluteal surface ofilium
ilium

Attachments
 Gluteus maximus: Upper fibers of gluteus maximus originate
from area behind posterior gluteal line
 Gluteus medius - Originates from area between anterior and
posterior gluteal lines
 Gluteus minimus - Originates from area between anterior
and inferior gluteal lines
 Reflected head of rectus femoris - Originates from shallow
groove between inferior gluteal line and acetabulum
 Surfaces of
ilium
Sacropelvic surface of ilium
 Lies on posteromedial side of ilium
 Situated behind medial border of ilium
 Rough or uneven and divided into three parts
• Iliac tuberosity
• Auricular surface
• Pelvic surface
 Surfaces of
ilium
Iliac tuberosity
 Rough area situated just below dorsal
segment of iliac crest
• Attachments
 Interosseous sacroiliac ligament
 Dorsal sacroiliac ligament - posteriorly
 Iliolumbar ligament - superiorly
 Surfaces of
Auricular surface
ilium
 Ear-shaped articular surface (L-shaped or C-shaped).
 Rough
 Lies anteroinferior to iliac tuberosity
 Covered by fibrocartilage
Articulation
 Articulates with reciprocal auricular surface of sacrum to
form sacroiliac joint
Pelvic surface of ilium
 Continuous with pelvic surface of ischium
 Smooth and lies anteroinferior to auricular surface
 Surfaces of
ilium
Preauricular sulcus
• Shallow sulcus – lies just in front of auricular
surface
• Deeper or well-demarcated in females than in males

Attachments
• Margins of preauricular sulcus give attachment to
anterior sacroiliac ligament
• Obturator internus originates from lower part of
pelvic surface
 PUBI
S

 Ilium or flank form upper flat and expanded plate of bone

 Projects above acetabulum

 Forms anteroinferior part of hip bone

 Also called pubic bone or os pubis

 PUBI
S

Parts of Pubis

Has following three parts

• Body
• Superior ramus
• Inferior ramus
 PUBI
Body of Pubis S
• Flattened anteroposteriorly
• Quadrilateral in outline
Has following
- Three surfaces: anterior, posterior, and
medial
- Pubic crest
- Pubic tubercle
 Body of
Pubis
Anterior surface of pubis
 Directed downward, forward, and laterally
Attachments
 Adductor longus - Originates from angle between
pubic crest and pubic symphysis
 Gracilis - Originates from lower part of body of pubis
 Origin extends on inferior ramus
 Adductor brevis - Originates lateral to gracilis
 Obturator externus - Originates near margin of
obturator foramen
 Body of Pubis
Posterior surface of pubis
 Smooth
 Forms anterior wall of true pelvis
 Separated from urinary bladder by retropubic pad of
fat
Attachments
 Gives attachments to following structures from
medial to lateral
• Medial puboprostatic ligament
• Levator ani muscle (origin)
• Parietal layer of pelvic fascia
• Obturator internus (origin)
 Body of
Symphyseal (medial)
Pubis surface of pubis
 Rough and articulates with opposite bone to form
symphysis pubis
 Covered by hyaline cartilage
Pubic crest
 Upper thick border of body of pubis forms crest
called pubic crest
Attachments
 Lateral head of rectus abdominis muscle and
pyramidalis muscle originate from lateral part of
 Body of
Pubis
Public tubercle
 Lateral end of pubic crest forms bony
projection called pubic tubercle
Attachments
 Medial end of inguinal ligament.
 Ascending loops of cremaster muscle
 In males, crossed by spermatic cord
 Body of
Pubis

Superior Ramus of Pubis

 Lies above obturator foramen
 Extends from body of pubis to acetabulum
 Triangular in cross-section
 Body of
Pubis

Superior Ramus of Pubis

 Has three borders and three surfaces
• Three borders – Anterior (obturator crest), superior
(pectineal line), and inferior
• Three surfaces – Pectineal, pelvic, and obturator
 Body of Pubis
Superior border (pectineal line) of superior
pubic ramus
 Also called pectineal line or pecten pubis
 Sharp and prominent
 Extends from pubic tubercle to iliopubic
eminence and then continues with arcuate line
 Body of Pubis
Superior border (pectineal line) of superior
pubic ramus
Attachments
 Medial part of pectineal line gives attachment
to
 – Lacunar ligament (pectineal part of inguinal
ligament),
 – Conjoint tendon of muscles of anterior
abdominal wall,
 Body of Pubis
Superior border (pectineal line) of superior pubic
ramus
 Lateral part of pectineal line gives attachment to
- pectineal ligament,
- pectineus muscle, and
- pectineal fascia

• Footnote: Lacunar ligament connects inguinal

ligament with pectineal ligament
• Pectineal ligament: Extension of lacunar ligament
 Body of
Anterior borderPubis
(obturator crest) of superior
pubic ramus
 Extends from pubic tubercle to acetabular notch
Inferior border
 Sharp border and forms upper margin of obturator
foramen
Attachment
 Obturator membrane attaches to inferior border
 Body of
Pubis
Pectineal surface of superior pubic ramus
 Lies between anterior border (obturator crest)
and superior border (pectineal line)
 Triangular in shape
 Extends from pubic tubercle to iliopubic
eminence
Attachment
 Pectineus muscle originates from pectineal
surface
 Body of
Pubis
Obturator surface of superior pubic ramus
 Lies between anterior border (obturator crest)
and inferior border
 Has groove called obturator groove
Transmits following structures
• Obturator nerve
• Obturator artery
• Obturator vein
 Body of
Pelvic surfacePubis
of superior pubic ramus
 Lies between pectineal line and inferior border
 Smooth
Relations
• Crossed by obliterated umbilical artery and vas
deferens in male and by round ligament of uterus
and obliterated umbilical artery in female
 ISCHIU
M

 Forms thick, posteroinferior part of hip bone

 Consists of body and ramus
 ISCHIU
M

Body of ischium • Three borders – Anterior,

posterior, and lateral
 Thick mass of bone
• Three surfaces – Femoral,
Has following dorsal, and pelvic
• Two ends – Upper and lower
 ISCHIU
M
Ends of body of ischium
Upper end of ischium
 Fuses with ilium and pubis at acetabulum
 Forms posteroinferior two-fifths of acetabulum
Lower end (ischial tuberosity)
 Forms ischial tuberosity
 ISCHIU
Borders of body M
of ischium
 Has three borders – anterior, posterior, and
lateral
Anterior border of ischial body
 Forms posterior margin of obturator foramen

Attachments
• Obturator membrane
 ISCHIU
M body
Posterior border of ischial
 Continuous above with posterior border of ilium
 Forms lower part of greater sciatic notch, ischial spine,
and lesser sciatic notch
Ischial spine
• Triangular bony projection
Attachments
- Sacrospinous ligament - attaches to margins of ischial
spine
- Levator ani - muscle originates from medial surface of
ischial spine
 Some interesting
facts
Spine of ischium: Dorsal surface of spine of
ischium is crossed by (mnemonics: PIN)
• Pudendal nerve,
• Internal pudendal vessels, and
• Nerve to obturator internus
 ISCHIU
Lesser sciatic notch of M
ischial body
• Shallow smooth notch
• Situated between ischial spine and ischial tuberosity
Attachments
- Superior gamellus originates from upper margin of
lesser sciatic notch
- Inferior gamellus originates from lower margin of lesser
sciatic notch
Lateral border of ischial body
 Forms lateral margin of ischial tuberosity
 Upper part of lateral border is indistinct
 Some Interesting
facts
 Gives passage to tendon of obturator internus
 Lesser sciatic notch is lined by hyaline cartilage
 ISCHIU
M
Surfaces of body of ischium
 Has three surfaces: Femoral, dorsal, and pelvic
Femoral surface of ischial body
 Lies between anterior and lateral borders
Attachments
- Obturator externus - originates along margin of obturator
foramen
- Quadratus femoris - originates from lateral border of upper part
of ischial tuberosity
 ISCHIU
Dorsal surface of ischial M
body
 Continuous above with gluteal surface of ilium
 Transverse groove divides dorsal surface of ischium into upper
and lower parts
 Groove gives passage to tendon of obturator internus with two
gamelli
 Lower rough part forms ischial tuberosity
Pelvic surface of ischial body
 Lies between anterior and posterior borders
 Attachment
- Obturator internus originates from pelvic surface of ischium
 ISCHI
Ramus of ischium UM
 Joins with ramus of pubis to form conjoint ischiopubic
ramus
.
 Ischial tuberosity

 Also called tuber ischiadicum or sit bone

 Large mass of ischium
 Divided by transverse ridge into upper
quadrangular and lower triangular areas
 Upper area is subdivided by oblique ridge into
• Superolateral area, which gives origin to
semimembranosus
• Inferomedial area, which gives origin to
semitendinosus and long head of biceps femoris

Human Anatomy/Yogesh Sontakke 76

 Ischial tuberosity

 Lower area – subdivided by longitudinal ridge into

• Outer area, which gives origin to ischial head of
adductor magnus
• Inner area, which is covered by fibrofatty tissue,
and transmits body weight in sitting position
 Margin of ischial tuberosity
• Medial margin gives attachment to sacrotuberous
ligament
• Lateral margin gives attachment to ischiofemoral
ligament
Human Anatomy/Yogesh Sontakke 78
 Conjoint ischiopubic ramus
 Inferior ramus of pubis joins with ramus of ischium to form conjoint
ischiopubic ramus
 Has two borders, upper and lower, and two surfaces, inner and outer
Upper border
 Forms lower margin of obturator foramen
 Attachment: Obturator membrane
Lower border
 Forms boundary of subpubic angle and part of pubic arch
 Lower border – more everted in males than in females due to
attachment of crus of penis
 Attachments: Fascia lata and membranous layer of superficial fascia
of perineum (Colle’s fascia)
 Conjoint ischiopubic
Outer surface ramus
 Rough
 Attachments
• Obturator externus originates near margin of
obturator foramen
• Adductor brevis (origin)
• Gracilis (origin)
• Adductor magnus (origin)
 Conjoint ischiopubic
Inner surface
 Convex and rough ramus
 Divided into three areas (upper, middle, and lower areas) by two
ridges (upper and lower)
 Attachments
- Upper ridge – superior fascia of urogenital diaphragm
- Lower ridge – perineal membrane (inferior fascia of urogenital
diaphragm)
- Upper area – origin of obturator internus
- Middle area – origin of sphincter urethrae and deep transverse
perinei
- Lower area – gives attachments to crus of penis/clitoris,
ischiocavernosus (origin), and superficial transverse perinei
 Obturator
 Large opening in hip bone

foramen
Situated below acetabulum, in between pubis and ischium
 Sex difference
• Large and oval in males and triangular in females
 Attachment: Obturator membrane – attached along margins
of obturator foramen
 Obturator canal
 At obturator groove, there – gap between obturator
foramen and obturator membrane called obturator canal
 Contents of obturator canal: Obturator nerve and vessels
 Acetabul
um

 Cup-shaped hemispherical cavity (acetabulum = little

vinegar in Latin)
 Direction: Directed laterally, downward, and forward
 Acetabular margin – deficient inferiorly
 This gap – called acetabular notch
 Acetabul
um

Attachments
• Transverse acetabular ligament
• Bridges gap of acetabular notch
• Margins of acetabular fossa near acetabular notch give
attachment to limbs of ligamentum teres femoris
 Acetabul
 Contributed byum
following bones: Anterior one-fifth –
Pubis Posterior two-fifths – Ischium Superior two-
fifths – Ilium
Articulation
 Receives head of femur to form ball-and-socket type
of synovial hip joint
 Lunate surface
 Horseshoe-shaped articular surface covered by
hyaline cartilage
 Acetabul
Acetabular fossa um
 Nonarticular central part of lunate surface filled
with pad of fat covered by synovial membrane
Contents
 Branches of obturator vessels and nerves passe
through acetabular notch
Acetabular labrum
 Ring of cartilage – attached to margins of
acetabulum
 OSSIFICATION OF HIP
 BONE
Ossifies from three
primary centers and five
secondary centers
 Primary centers
• 1 for ilium – appears by
2nd month of IUL
• 1 for ischium – appears
by 4th month of IUL
• 1 for pubis – appears by
4th month of IUL
 OSSIFICATION OF HIP
BONE
 Primary centers
• Fusion of primary
centers results in Y-
shaped triradiate
cartilage in floor of
acetabulum
 Ischium and pubis fuse
to form conjoined
ramus from 7th to 8th
year of age
 OSSIFICATION OF HIP
BONE
Secondary centers
• 1 for ischial tuberosity
• 2 for iliac crest
• 2 for Y-shaped triradiate cartilage
All secondary centers appear by puberty and all centers fuse by 25th
years of age
 Some interesting
 facts
Pubis – usually lost from prenatal remains as ossified
later than ilium and ischium
 Fusion of bones occurs at acetabulum between 16 th
and 18th years of age
 Risser sign
• Indicates skeletal maturity based on degree of
ossification of iliac crest and iliac bone by X-ray
evaluation
• Useful in determining optional timing of surgery
for spinal deformity
 Some interesting
factsof pelvic apophysis
• Avulsion fractures
• Excessive muscular pull in athletic
adolescents may cause avulsion fractures of
pelvic apophysis
• For example: avulsion fracture of pelvic
apophysis; avulsion fracture of anterior
inferior iliac spine by pull of rectus femoris
muscle
THANK YOU!!!

Human Anatomy/Yogesh Sontakke 98