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Osteology of the Pelvis TJ PinchemainRules & disclaimers •Please turn off camera and microphone •Ask questions in the chat, facilitator or tutor will get to it •Please give feedback to the tutors at the end – link at the end •Zoom will be recorded- by participating, you are giving permission to be recorded My rules: 1. Please send me questions Iʼve finished talkingen 2. Laugh at my memesLearning outcomes •What are the bones of the pelvis?? •What is the blood supply of male reproductive organs?? •What supplies the female reproductive organs? The Ilium •Widest and largest of the bone. The Hip Bone •Located superiorly Three parts of the hip bone: •The body forms the superior • Ilium • Pubis part of the acetabulum • Ischium Three main articulations: • Sacroiliac joint •Two surfaces of the wing of • Pubic symphysis • Hip joint ilium: • Inner – concave shape + produces the iliac fossa (iliacus muscle) • External – has a convex shape (gluteal muscle attachments) Superior margin is thickened – iliac crest and gives rise to the Anterior Superior Iliac Spine (ASIS) and An indentation known as the greater sciatic notch is the PSIS present on the posterior aspect of the iliumThe Hip Bone The Pubis •The most anterior portion of the hip bone, consists of: Three parts of the hip bone: • Pubic body • Ilium • Superior pubic ramus • Pubis • Ischium • Inferior pubic ramus Three main articulations: • Sacroiliac joint • Pubic symphysis The superior + inferior rami • Hip joint enclose the obturator foramen (obturator NVA pass through) The Ischium •Forms the posteroitferior part The Hip Bone of the hip bone •Composed of: • Body Three parts of the hip bone: • Inferior ramus • Ilium • Superior Ramus • Pubis • Ischium Three main articulations: Inferior ischial ramus combines • Sacroiliac joint with the inferior pubic ramus to • Pubic symphysis • Hip joint form the ischiopubic ramus (obturator foramen) Posterioinferior aspect forms ischial tuberosities (body weight rests here)The Sacrum Bony landmarks: •Base •Apex Sacral vertebrae: •Auricular surfaces •Anterior and posterior surfaces • There are 5 Central canal of the vertebral column continues along the sacral core and ends at the sacral hiatus (4 sacral foramina) The Coccyx •Consists of: • Apex • Base • Anterior surface • Posterior surface • 2 x lateral surfaces •Base – located superiorly + articulates with sacrum •Apex – Situated inferiorly at the terminus of the vertebral column •Articulates at a fibrocartilaginous joint (sacrococcygeal symphysis) – movement is limited to minor flexion and extensionVasculature - Arteries Arterial supply Internal Iliac Artery Originates at the bifurcation of the common iliac artery@ L5-S1 the pelvic inlet – situated medially to the external iliac vein and obturator nerve greater sciatic foramen it divides into: • Interior trunk • Posterior trunk Arterial supply – Anterior Iliac trunk Artery Course What it supplies Obturator artery Travels through the obturator canal Muscles of the thigh’s adductor region Accompanied by obturator nerve and vein Umbilical artery Gives rise to Superior vesical artery Superior aspect of the bladder (deoxygenated blood from foetus to placenta) Inferior vesical artery Lower aspect of the bladder + prostate and seminal vesicles (men) Vaginal artery (female only) Descends to the vagina Vagina + inferior bladder + rectum Uterine artery (female only) Travels within cardinal ligament to cervix. Anastomoses with the ovarian artery Middle rectal artery Medially to supply the distal part of the rectum Internal pudendal artery Exits the pelvis superiorly via the greater The perineum sciatic foramen. Enters the perineum via lesser sciatic foramen Inferior gluteal artery Exits via greater sciatic foramen, emerging Gluteal muscles and hip joint inferiorly to piriformis Arterial supply – Anterior Iliac trunk Arterial supply – Posterior Iliac trunk Artery Course What it supplies Iliolumbar Ascends to exit the lesser Lumbar branch: Psoas major, pelvis, dividing into a lumbar quadratus lumborum, posterior and iliac branch. abdo wall Iliac branch: muscles and bone around iliac fossa Lateral sacral arteries (sup and Inferio-medially along the Sacral canal, skin and muscle inf) posterior pelvic wall posterior to sacrum Superior gluteal Exits via greater sciatic skin and muscles of gluteal foramen, entering gluteal region region superiorly to piriformis Arterial supply – Minor arteries Artery Course What it supplies Ovarian artery Major gonadal artery (women) Ovarian branch – Ovaries! Arises from abdo aorta, distal to renal arteries Tubal branch – Ovarian tubes Descends towards pelvis via pelvic prim Moves medially dividing into ovarian and tubal branch Median sacral Originates from posterior aspect of abdo L4, L5 Vertebrae + sacrum and aorta at its bifurcation into common iliac coccyx arteries Descends anteriorly to L4 and L5 vertebrae, sacrum and coccyx Superior rectal Terminal continuation of inferior mesenteric Gives rise to branches that artery, crosses the left common iliac artery + supply the rectum descends in the mesentry of sigmoid colon Arterial supply – Ovarian artery The path – in more detail 1. Arises from abdominal aorta 2. Descends towards pelvis crossing the pelvic brim + origin of external iliac vessels 3. Moves medially dividingVasculature - Veins External Iliac vein Course: Is a continuation of the femoral vein (lower limb draining) Arises when the femoral vein crosses underneath the inguinal ligament It ascends along the medial aspect of the external iliac artery Joins with the internal iliac vein to from the common iliac vein Drains: 1. Inferior epigastric vein 2. Deep circumflex iliac vein Internal Iliac vein Course 1. Formed near the greater sciatic foramen 2. Ascends anteriorly to the sacroiliac joint Drains 3. Combines with the external iliac vein to give 1. Superior and inferior gluteal veins – buttock and upper thigh common iliac vein 2. Internal pudendal vein – repro organs + rectum 3. Obturator vein 4. Lateral sacral veins – sacrum 5. Middle rectal vein – bladder, prostate + rectum 6. Vesical veins – urinary bladder Course 7. Uterine and vaginal veins – female repro organs 1. Formed near the greater sciatic foramen 2. Ascends anteriorly to the sacroiliac joint 3. Combines with the external iliac vein to give common iliac vein Common Iliac vein Not important but clinical relevance: The veins in the pelvis, particularly the ovarian Course: veins in women, are prone to valve failure that may cause them to become dilated and tortuous (similar to varicose veins of the leg). This can cause Formed at the upper margin of the pubic symphysis by the union of external and internal intense pain within the pelvis, known as pelvic iliac veins congestion syndrome. The pelvis contains too many structures to successfully dissect out a vein, and so pelvic venous embolization is performed instead. Drains: Using a venous catheter, a guide wire is fed through, a contrast dye is used and affected vessels 1. Illolumbar vein – drains, L4/L5 + iliopsoas are embolised (blocked) with various substances, 2. Middle sacral veins – drains sacrum such as metal coils. Due to the rich venous anastomoses in the pelvis, one smaller vein can be tied off without compromising venous return.Penis blood supplyArterial Supply Venous drainage The penis receives arterial supply from three arteries: - Dorsal arteries of the penis From the penis by paired veins (ie bulbourethral vein) - Deep arteries of the penis The cavernous spaces drained by deep dorsal vein into prostatic venous plexus. - Bulbourethral artery Superficial dorsal veins drain superficial structures like All of these branch from the internal pudendal artery skin and cutaneous tissues (anterior division of the internal iliac art.)Thank you Cheers for listening if you have any questions that you don’t want to ask on the chat or questions about the slides after you get them, hit me up by email or Facebook: PinchemainTW@cardiff.ac.uk TJ Pinchemain TJ.Kresovic