hey guys so the uh next structure that we're really going to go over in detail is going to be the innominate bones or the hip bones um and just to give you guys a little bit of context before we go into the specific structures this would be one innominate bone and then this would be the opposite side okay so there are two inominate bones that sit in the body and then to form the pelvic girdle the two inominate bones will articulate posteriorly with the sacrum so if you think back to the vertebrae video you know that the sacrum sits at the bottom of the vertebral column and it's going to form the uh posterior part of the pelvis okay now when you see the two um phenomena bones together like this it can also be referred to as os coxae okay so if you see that term this is the region that we're talking about here okay so i'm going to go ahead and take this away and we're just going to focus on one anomaly bone for now okay now i personally think that the anomaly bone is one of the more difficult bones especially when it comes to orientation so trying to figure out what is anterior what's posterior what's medial what's lateral all these things can be a little different so as i rotate the bone you'll see there are so many different points of view and as i move it there's all these different structures here that we're going to have to name so because some of these structures are named for where they are in orientation on the anomaly bone we need to make sure that we make orientation a priority so the first thing that we'll talk about is how to orient yourself you know how to figure out what's up what's down what's in what's out so there are a couple ways to figure out the orientation of the innominate bone i personally used two things i used this part of the bone right here this very pointy part okay this is known as the pubis we'll go over that a little bit later but i always just remember the pointy part points forward okay the pointy part points forward so the pubis is going to be very anterior and you can actually see if you have two anomaly bones like this forming the pelvis the pointy part the pubis or the pubic bone points anteriorly and then posteriorly we would have the sacrum back there um between the two anomaly bones so the pointy part the pubis points anteriorly it points forward so that tells me that this is going to be anterior and then this is going to be posterior okay the other thing that you really need to make sure that you know how to do is figure out what's medial and what's lateral this is going to help us determine the difference between like a left and a right innominate bone um the way that i determine medial from lateral is i look for this very large structure right here this is known as the acetabulum okay the acetabulum and the acetabulum we'll go over in a little more detail later but this is going to be where the head of the femur articulates and that has to happen on the lateral aspect of the innominate bone okay so the acetabulum is always going to face laterally this side would be more medial okay so this would be like inside of the pelvis this would be out here on the outside forming your hip joint okay all right so i use the pubis pointing forward to figure out what is anterior and then i also use the acetabulum to determine what is more lateral so as i stated um the innominate bone can be a little complex as far as bones are concerned if you've watched any of the other videos that have the bones of the lower extremity you'll see that those bones like the femur the tibia the fibula those are fairly straightforward long bones this one is just a very irregular shape and has a lot of structures on it and i think in my opinion the only bone that's really more challenging than this one would be the skull okay so make sure that you take the time dedicate the time to really study this from different points of view because we can orient this any way that we really want to on an exam so the way that i like to teach the innominate bone is by breaking it up into its three parts so if you didn't know this there are three parts to the anomaly bone there's the ilium the ischium and the pubis so if i were to cover all of this this very large part at the top here that would be the ilium okay so that whole area that you can see right now that would be the ilium and then i'm going to turn this a little bit this would be a medial view okay so this is like if you were inside of the pelvis looking out at the hip okay this area right here that's more anterior we said was the pubis it can also be called the pubic bone okay that's the pubis or the pubic bone and then this area back here this is known as the ischium so we have the ilium up here ischium down here and then the pubic bone or the pubis out here so let's start off on the ilium okay so we're going to go just to the top portion right here there are a few structures on the ilium that you need to know first off if we were to just pin the ilium itself on this large surface right here this would be known as the iliac wing the iliac allah or the iliac fossa okay so this surface technically has three names iliac wing iliac allah or iliac fossum the reason for that is is if you look at the surface i know it's probably hard to tell in the video but this surface is kind of depressed it's a smooth depressed surface and if you remember from like your vocabulary video a smooth depressed surface that's going to be called a fossa okay so this can be called a fossa and wing and allah actually just mean the same thing but in different languages okay so this is the iliac wing allah or fossa if we flip this over to a posterior view this is no longer depressed just you can't press in on it okay so this would just be iliac wing or allah no fossa okay so on the back here if we were to pin there would only be two names iliac wing and iliac allah but if we pin it on the anterior side here where it's kind of smooth and pressed in this would be the iliac wing allah and fossa okay so you could see any of those names on an exam the most superior portion so the highest portion of the innominate bone is known as the iliac crest okay so this line is known as the iliac crest the iliac crest is a very important landmark because you can very easily palpate it in a person and it falls at the level of l4 so it's a great landmark for something like a lumbar puncture so if you didn't know this a lumbar puncture can some sometimes be used to either gain access to cerebrospinal fluid to analyze the makeup of the fluid but it can also be used to as an injection site but we need to make sure that when we're sticking a needle in someone's back that we're not just putting it anywhere because we know the spinal cord sits inside of the vertebral column and if we put a needle in the spinal cord that's going to be bad news for your patient so we need to know where the spinal cord terminates and you start getting those beautiful cascade of nerves that we talked about with the sacrum okay so in an adult the spinal cord ends at the lower level of l1 so right around l1 l2 we're talking vertebrae here so in order to do a lumbar puncture you want to make sure that you insert your needle well below that point so that you're not hitting the spinal cord so in an adult a lumbar puncture can be performed either between the l3 and l4 vertebrae or between the l4 and l5 vertebrae those are safe zones to put a needle in an adult in a newborn actually the spinal cord terminates a little bit lower down closer to like l3 so it wouldn't really be safe to stick a needle between l3 and l4 because you could potentially hit the spinal cord so in a newborn you would perform the lumbar puncture at the level of l4 l5 so the space in between the l4 and l5 vertebrae the reason why we use iliac crest is that that is a really great way to determine the level of l4 so a lot of times what you'll see is the hip bones the iliac crest there can be palpated or felt with the hands and you can probably feel your own hip bones just by placing your hands at the top there and that's your iliac crest then you would draw a line in between the iliac crests on the back okay that is going to be the line at the level of l4 so when an adult you know you can go just a little bit up or a little bit down and you'll be safe in a newborn you would definitely just have to go below that l4 between l4 and l5 because that's the safe zone for a newborn so the iliac crest is a very important structure to know the next structures that i want to go over on the ilium kind of all go together it's going to be these points here one two three four and these are the four iliac spines these are all named for where they are in orientation so again if you can't figure out what is anterior and what is posterior you might have some trouble naming these structures so don't forget to study orientation okay so if we start off on this side okay this is the same side as the pubis so if we remember at the beginning of the video i told you guys that the pubis the pointy part points forward so this side is technically more anterior and that is because the bone doesn't sit flat like this in the body we saw it forms kind of like a bowl okay like this so we can see how technically in the body this area would be more anterior this area would be more posterior okay so when we're naming these spines this guy right here would be the anterior superior iliac spine okay anterior superior iliac spine anterior because remember this set is more anterior than this set okay and superior because this one is on top of this one so we have the anterior superior iliac spine here and then we'll have the anterior inferior iliac spine here okay so those are the two anterior spines right then if we move back here okay this one would be the posterior superior iliac spine again because this side is a little more posterior than this side and superior because this one is above this one so this one is the posterior superior iliac spine and then this one down here would be the posterior inferior iliac spine and that term iliac is just referring to the ilium so this whole part of the bone you'll hear that term actually a lot throughout the course iliac is referring to the ilium okay and then really the final structure on the ilium that you need to know is this very rough portion right here okay this is going to be the iliac tuberosity okay the iliac tuberosity now in dr dao's lecture video she went over some of the vocab terms with you and this is where you're really going to have to apply those because there are three t words that mean like a raised portion of bone a tubercle a tuberosity and a trochanter okay so if you remember if you think back to that slide a tubercle is just like a small raised portion of bone so it kind of like appears as like a small bump tuberosity is a fairly larger rough surface like this and then a trochanter is even larger so that's going from the smallest to the largest the trochanter is so large there's really only two in the body okay so tuberosity on the ilium we call it iliac tuberosity and remember that's going to be where the sacrum articulates okay so now that we're done with the ilium we can move down to another part of the innominate bone um i'll go down here to the ischium okay so this down here is going to be the ischium right and on our way down to the ischium we're going to pass a couple of structures so there's this first little rounded portion here almost looks like someone took a scoop right out of the bone okay this little rounded portion right here this is known as the greater sciatic notch okay the greater sciatic notch all right so that one's on top here and then you get to this point here and then it looks like someone took like a little scoop out okay so this was the big scoop the grater scoop and then we have the little scoop here so this would be the lesser sciatic notch okay the lesser sciatic notch now the point in between the two is known as the ischial spine so that's this little pointy thing right here that is the ischial spine so it goes greater sciatic notch ischial spine lesser sciatic notch okay on the very bottom here there's a rough surface i'm going to turn this a little bit so that you can see it a little bit better so this would be on the inferior aspect the very bottom of the anomaly bone there's this large rough surface right here okay this is known as the ischial tuberosity okay ischio referring to the ischium tuberosity remember is our second largest t word all right so the ischial tuberosity here and that's actually the part of the bone that you sit on so if you're sitting up straight and not slouching if you sit up straight and kind of rock forward and back you're actually rocking on your ischial tuberosity the final structure on the ischium i'm going to turn this is a medial view of the innominate bone okay so again this is like if you were inside of the pelvis somehow and staring out towards the hip okay so this is a medial view so we just finished the ischial tuberosity here if you follow that up there's this hole okay there's this hole here but there's this branch kind of coming up from the ischium heading toward the pubis this is known as the ischio ramus this branch right here is the ischioramus okay ramus is just the anatomical term for branch okay so in case you're like that is a really weird word it just means branch okay and the ischioramus be careful because it only comes to about this point here okay so everything behind my pin so all this right here this would all be ischioramus but if we go anterior here it's something else okay so just remember if you draw a line right around halfway through the branch everything posterior is ischial ramus and then everything anterior is going to be something else it's going to be in reference to the pubic bone okay so let's go ahead and head to the pubic bone now that again is one of the more anterior parts okay so this is an anterior view right and the pointy part is pointing forward okay so at the very tip here on the pubic bone you can see there's a small raised portion here just like a little bump okay and that is the pubic tubercle okay this little bump right here is the pubic tubercle and then we have this flat surface right here and this is known as the symphyseal surface okay the symphyseal surface okay so the symphysial surface is what you would name this area if you only have one anomaly bone however if you have two anomaly bones as you would in the pelvis this area becomes like a symphyseal joint here with a piece of cartilage in between there okay so one by itself right here would be some physial surface but if you have two together as you would in the pelvis like this that area would now be known as pubic symphysis okay pubic symphysis and just to kind of show you guys on one other model that we have this is kind of how the pelvis sits together right we have our two innominate bones our sacrum posteriorly you can see how the pubic bones come forward and then there's this piece of cartilage in the middle so if you have both a nominated bones here and you can see that cartilage and we pin here that would be pubic synthesis okay pubic symphysis however if we have just the one innominate bone and we pin that flat surface there that would be the symphyseal surface okay thus some symphysial surface okay i'm going to turn this again to that medial view okay so we're coming from the midline looking out at the hip all right and if you remember down here this was that ischial ramus but i told you guys it only comes to about halfway okay so if you look at the pubic bone in reference to the other bones like the ilium and the ischium there's two branches one up here and then one down here kind of reaching out to connect to the other parts of the bone okay so each one is going to be a ramus this one up here which is more superior is known as the superior pubic ramus okay the superior pubic ramus okay going from the pubic bone back towards the body of the anomaly bone here remus remember just means branch and then down here we have the inferior pubic ramus okay the inferior pubic ramus okay once you get halfway that becomes ischial ramus so if we pin back here it would be ischial ramus if we pin more towards the front here that would be inferior pubic ramus okay now we've been kind of naming structures all around this hole but as we know in the human body we don't just have holes for no reason okay so anytime we have a hole in a bone it is known as a for ramen okay and this is so that some critical structures can pass through this furamin here this is known as the obturator for ramen the obturator for ramen and you'll see um some of the things that like pass through here would be like the obturator nerve the obturator artery the obturator vein so there's structures that pass through here that are very important and that's why we have this hole in the bone okay now with the greater sciatic and lesser sciatic notches in the body those also are closed in and form foramen as well so this would become the greater sciatic for ramen and this would become the lesser sciatic for ramen but that is only when the bone is actually in the body because there are going to be two ligaments there that kind of close these holes in okay i'm just going to take this real quick to a more lateral view so this would be from a side view okay so we can still see the pubis here the ilium here the ischium down here and the obturator for ramen we have this large cavity right here which again is known as the acetabulum okay the acetabulum and that is where the head of the femur articulates okay the acetabulum okay and remember it always faces laterally so that's a great way to get orientation there are two small structures on the acetabulum specifically that you need to know and there's if you look around the acetabulum it almost looks like there's a ridge all the way around it and then all of a sudden there's this area where it dips down and there's no ridge i'm just going to kind of turn this so you can try to see see how there's this nice crisp line all the way around and then all of a sudden you get to this point here and there's no line okay that is known as the acetabular notch okay so all the way around we have this line and then down here we have no line that is the acetabular notch and then if you look down inside of the acetabulum there's this area that's smooth and pressed in okay like it's indented here okay and you guys remember what we call a smooth depressed surface a fossa okay so this area specifically in here would be the acetabular fossa this depression inside of the acetabulum and that's going to be it for your inominate bone so real quick before we get lots of questions on all the clinical stuff i was spouting earlier we have a piece of paper here that has the the levels of termination for the spinal cord in both the adult and the newborn and then where you would perform the lumbar puncture so i'll give you guys a second to take a look at that write down any notes and then remember if you have any questions on this kind of stuff you can always attend the office hours that agnes and i are holding