GRDA Intro Bony Pelvis

INTRODUCTION TO BONY PELVIS
Identify the bones and bony landmarks of the pelvis
Bony Landmarks
 In a mature individual, the pelvis is composed of 2 pelvic (hip) bones, sacrum, and coccyx.
 The 2 pelvic hip bones (right and left pelvic bone) are formed by the fusion of 3 bones:
1. Ilium 2. Ischium. 3. Pubis.
o At birth, the 3 bones are connected by cartilage in the area
of the acetabulum. At adult age, they fuse into a single
bone.
 NB = Look at picture to identify important features
 The 2 hip bones are joined anteriorly at the pubic symphysis
 The hip bones articulate with the sacro-iliac joints to form

the pelvic girdle
 The 2 ischiopubic rami form the pelvic arch
 NB = In anatomical position, the anterior superior iliac spines

(ASIS) and the front edge of the pubic symphysis lie in the same
vertical plane. This allows the pelvic bones to bear more weight
the soft tissues of the anterior abdominal wall
Sacro-iliac joint
 It is a strong weight bearing compound joint. It has 2 types of
joints within it:
1. Anterior synovial joint
o This joint is between the ear-shaped auricular surfaces
of the sacrum and ilium
2. Posterior fibrous joint (syndesmosis)
o This joint is between the tuberosities of these bones
 The auricular surfaces of the synovial joint interlock and are
reinforced by sacro-iliac ligaments
o There are 3 sacro-iliac ligaments: 1. anterior sacro-iliac
ligaments 2. posterior sacro-iliac ligament. 3. interosseous sacro-iliac
ligament which is the largest and strongest of the 3. It is lies deep to
posterior sacro-iliac ligament and is involved in transferring of upper
body from axial skeleton to the 2 ilia of the appendicular skeleton.
 The joint is innervated by anterior and posterior rami of S1 – S2
Explain how to estimate pelvic diameter

Sex differences
 The female pelvic inlet is circular while the men pelvic inlet is heart shaped.
 Females have less distinct promontory while that of men are prominent
 The pubic arc is greater in females (around 80-85o) than it is in men which
is around 50-60o
 The ischial spines in male are tinted or project medially, while that of females
do not and are directed inferiorly
Pelvic Diameters
 The narrowest fixed distance through which the baby’s head must pass in vagina delivery is measured by the obstetrical
conjugate. This is measured from the middle of pubic symphysis posteriorly to the tip of the sacral promontory posteriorly
(~11cm).
 The obstetrical conjugate angle is difficult to measure because of the bladder, the diagonal conjugate is used to estimate it.
This is measure from the lower border of the pubic symphysis to the tip of the sacral promontory (~12.5cm) with the middle
finger.
Describe the openings, ligaments, and muscles of the pelvis
Ligaments of the pelvic wall

 Two important ligaments convert the greater and lesser sciatic
notches of the pelvic bone into greater and lesser sciatic foramina
out of the bony greater and lesser sciatic notches. These ligaments
are:
1. Sacrospinous ligament: sacrum/coccyx to ischial spine
2. Sacrotuberous ligament: ilium/sacrum to ischial tuberosity
o There is also the obturator foramen, formed by the ischium

and the pubis bone is closed by the obturator membrane
 The obturator member has an opening called the
obturator canal through which obturator nerve and
vessels pass into the medial compart of the thigh
Ring Bone Rule (holds true for the pelvis)

 In a ring bone if you see a fracture or dislocation in one part of that
bone, look for another. It is like braking trying to break a pretzel.
 Humans have 3 bony rings: a pelvic inlet and 2 obturator foramens.

 Humans have 4 fibrous osseous rings: 2 greater sciatic and 2 lesser
sciatic foramen
Pelvic Muscles and Nerves

 Two muscles form the lateral walls of the pelvis, and they are:
1. Piriformis--- passes through the greater sciatic foramen; it is innervated by the nerve to piriformis; it lateral/externally
rotates the thigh.
2. Obturator internus---makes a 90o turn and exits the lesser sciatic foramen to insert on the greater trochanter of the femur;
it is innervated by nerve to obturator internus; it lateral/externally rotates the thigh.
Sciatic foramina
 As alluded, muscles and ligaments create several foramina:
1. Greater foramina. The piriformis muscle divides the greater foramina into 2 parts:
 The superior gluteal nerve and vessels pass through the foramen above the piriformis muscle
 The following pass belove the muscle: inferior gluteal nerves and vessels, sciatic nerve, pudendal nerve, internal
pudendal artery and vein, posterior femoral cutaneous nerves, nerves to obturator internus, and nerves to
quadratus femoris muscles

2. Lesser foramina. Structures passing through here includes: tendon of obturator internus muscle, nerve to obturator
internus muscle, pudendal nerve, internal pudendal artery, and vein.
NB =. the pudendal nerve and internal pudendal vessels loop around the ischial spine and sacrospinous ligament to pass
through the lesser sciatic foramen to enter the peritoneum.
Pelvic floor
 The pelvic floor is fascia, ligaments, muscles, connective tissue.
 It separates the pelvic cavity above from the perineum. It is formed by

a hammock-like pelvic diaphragm.
NB = Everything above pelvis floor is true pelvis and every below the
pelvis floor is called the perineum
 The pelvic diaphragm is formed by the levator ani and the coccygeus
muscles from both sides.
 Between the medial borders of the levator ani muscles is anterior

opening called urogenital hiatus—gives passage to the urethra (in
both males and females) and, in females, the vagina
Describe the components and functions of the pelvic diaphragm
Function
 The perineum contains the external genitalia, and external openings of
the urinary genitalia and gastrointestinal system. So, the pelvic floor is
for things above in the true pelvic and things hanging off it inferiorly.
Components of the pelvic diaphragm are the following:

1. Coccygeus (ischiococcygeus) fused to the sacrospinous ligament
2. Levator ani is a broad muscular sheet, composed of
a. iliococcygeus (most lateral) b. pubococcygeus (middle—comes from the pubic to the coccygeus) and c. puborectalis
(comes from the pubic bone and wraps around the rectum)
o The levator ani is larger, more important part of the pelvic floor
i. Attached to the bodies of the pubic bones anteriorly, the ischial spines posteriorly, and thickening in the
obturator fascia (the tendinous arch of the levator ani) between the two bony sites on each side
ii. They are innervated by nerve to levator ani and coccygeus (s3-s4)
Clinical significance of pelvic diaphragm
 Puborectalis originates from the pubis and passes inferiorly on each side to form a sling
around the terminal part of the gastrointestinal tract.
 This muscular sling maintains an angle or flexure, called the perineal flexure, at the
anorectal junction. This angle functions as part of the mechanism that keeps the end of
the gastrointestinal system closed.
 In other words, this muscle is import for fecal continence. Thus, weakness may contribute to
rectal incontinence
 NB = The levator ani is tonically contracted most of the time to support the abdominopelvic viscera and to assist in maintaining
urinary and fecal continence

GRDA Intro Bony Pelvis

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INTRODUCTION TO BONY PELVIS

Identify the bones and bony landmarks of the pelvis

 NB = Look at picture to identify important features

 The 2 hip bones are joined anteriorly at the pubic symphysis

 The hip bones articulate with the sacro-iliac joints to form

 The 2 ischiopubic rami form the pelvic arch

 NB = In anatomical position, the anterior superior iliac spines

 The joint is innervated by anterior and posterior rami of S1 – S2

Explain how to estimate pelvic diameter

Ligaments of the pelvic wall

o There is also the obturator foramen, formed by the ischium

Ring Bone Rule (holds true for the pelvis)

 Humans have 3 bony rings: a pelvic inlet and 2 obturator foramens.

Pelvic Muscles and Nerves

 It separates the pelvic cavity above from the perineum. It is formed by

 Between the medial borders of the levator ani muscles is anterior

Describe the components and functions of the pelvic diaphragm

Components of the pelvic diaphragm are the following:

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