1. Subinguinal hiatus, femoral triangle, adductor canal, etc…
Ákos Lukáts M.D., Ph.D.

2. In and out from the pelvis
Greater schiatic foramen - suprapiriform hiatus
- infrapiriform hiatus
Lesser schiatic foramen (to perineum)
Obturator canal
Subinguinal hiatus (from pelvis major)

3. Schiatic foramina Greater schiatic foramen Obturator canal
Subinguinal hiatus
Sacrospinous lig.
Sacrotuberous lig.
Inguinal lig.
Lesser schiatic foramen
Obturator membrane (+ m. obt. Ext, int.)

4. Lesser sciatic foramen : They enter the ischiorectal fossa!
Gluteal region - sacral plexus
Suprapiriform hiatus :
superior gluteal a., v., n.
Infrapiriform hiatus:
inferior gluteal a., v., n.
sciatic n. (committing a.)
posterior femoral cut. n.
internal pudendal a., v.
pudendal n.
Lesser sciatic foramen :
internal pudendal a., v.
pudendal n.
They enter the ischiorectal fossa!
Sobota - Atlas of Human Anatomy

5. Intramuscular injection
Triangular technique
(trochanter major, anterior superior iliac spine, iliac crest)
NOT to hit: superior gluteal
a., v., n.
Sobota - Atlas of Human Anatomy

6. Subinguinal hiatus – lumbal plexus, a. et v.
Iliopectinate arch
Lacuna musculonervosa:
lateral cutaneus femoral n.
m. iliopsoas
femoral n.
Lig. lacunare
Lacuna vasorum:
femoral a., v.
genitofemoral n. (femoral br.)
Lacuna lymphatica (herniosa):
lymph vessels
Inner opening of femoral canal!!
(anulus femoralis)
Sobota - Atlas of Human Anatomy

7. Femoral triangle / iliopectineal fossa
Borders of the femoral trigone:
m. sartorius (lat), m. adductor longus (med)
fascia lata (spf. - sapheneal hiatus – cribriform plate – spf. connection)
m. iliopsoas, m. pectineus (deep)
subinguinal hiatus (sup. connection)
Adductor canal (inf. connection)

8. Femoral triangle / iliopectineal fossa
Borders of iliopectineal fossa:
m. iliopsoas, m. pectineus (iliopectineal fascia)
fascia lata (sapheneal hiatus – cribriform plate

10. Femoral triangle / iliopectineal fossa
Connections:
subinguinal hiatus : femoral a., v., genitofemoral n. (femoral br.), lymph vessels, (femoral n.)
sapheneal hiatus : greater saphenous v. genitofemoral n. (femoral br.), lymph vessels
adductor canal : femoral a., v., saphenous n.
Femoral nerve runs under the iliopectineal fascia!!!
Sobota - Atlas of Human Anatomy

11. Femoral artery in superficial position – risk of injury!!!
Sobota - Atlas of Human Anatomy
Palpatable femoral artery!
First aid!!
Arterial puncture!
Regions supplied by spf. and deep inguinal lymph nodes:
lower extremity, inferior superficial part of abdominal wall, external genital organs (NOT THE TESTIS!!!)
drain further to the pelvic nodes near the. Iliac artery.
Lymph node enlargement is fairly common, mostly caused by banal infection.

12. Palpation and Compression of the Femoral Artery.

13. Sobota - Atlas of Human Anatomy
Adductor canal
Borders:
m. vastus medialis (lat.),
m. adductor longus et magnus (med.)
lamina vastoaductoria (spf.) – m. sartorius above
Content: femoral a., v., sapheneus n. (ARTERY SUPERFICIAL)
Connections:
femoral triangle (iliopectineal fossa ): femoral a., v., sapheneus n.
adductor hiatus : femoral a., v. – popliteal a., v.
The sapheneus n. and the descending genicular artery penetrate the lamina vastoaductoria.
Sobota - Atlas of Human Anatomy

14. m. semitendinosus et semimembranosus
ant. cut. fem. nn.
Femoral a., v., sapheneus n.
Extensors
Greater saphenous v.
m. rectus femoris
Flexors
m. vastus intermedius
m. sartorius
Adductors
m. vastus medialis
m. vastus lateralis
m. adductor longus
lat. cut. fem. n.
r. cut. of obturator n.
m. adductor magnus
sciatic n., a commitans n. ischiadici, aa. perforantes
m. gracilis
m. biceps femoris
m. semitendinosus et semimembranosus
post. cut. fem. n
Sobota - Atlas of Human Anatomy

15. Popliteal fossa Borders:
m. semitendinosus et semimembranosus (sup. med.)
m. biceps femoris (sup. lat.)
m. gastrocnemius medialis et lateralis (inf. med / lat.)
Base:
femur (popliteal surface), m. adductor magnus, capsule of knee joint, m. popliteus
Deep outflow under the origin of soleus m.
Covered superficially by popliteal fascia.
Contents: popliteal a., v., tibial n. , common peroneal n. (sciatic n.), lesser saphenous v., lymph vessels, med. and lat. cut. surral nerve. (surral n.), collateral arteries/veins of the knee.
Palpatable popliteal artery!
Sobota - Atlas of Human Anatomy

16. Sobota - Atlas of Human Anatomy
Connections:
adductor hiatus : femoral a., v. – popliteal a., v.
From the groove between flexors of the knee: tibial n., common peroneal n. (sciatic n.)
Under the origin of soleus m : popliteal a. (ant/post tibial a.), tibial n.
Penetrating the popliteal fascia: lesser saphenous v., lymph vessels, med. and lat. cut. surral n. (surral n.)
common peroneal n.
Sobota - Atlas of Human Anatomy

17. Subinguinal hiatus – femoral canal.
Lacuna musculonervosa:
lateral cutaneus femoral n.
m. iliopsoas
femoral n.
Lig. lacunare
Lacuna vasorum:
femoral a., v.
genitofemoral n. (femoral br.)
Lacuna lymphatica (herniosa):
lymph vessels
Inner opening of femoral canal!!
(anulus femoralis)
Sobota - Atlas of Human Anatomy
Femoral canal: septum femorale, l. lymphatica, femoral triangle (iliopectineal fossa), saphenous hiatus
Femoral herniation (especially common in females)c

18. About 1.3cm long , and its upper opening is called the femoral ring
Contains: a little loose fatty tissue, a small lymph node, and some lymph vessels.

19. Femoral canal: septum femorale, l
Femoral canal: septum femorale, l. lymphatica, femoral triangle (iliopectineal fossa), saphenous hiatus
Femoral herniation (especially common in females)

20. Femoral hernia
From: Google search.com

21. Corona mortis Corona mortis
Netter: Atlas of Human Anatomy
Corona mortis
Corona mortis
Anastomosis between external iliac and obturator arteries.
Danger during femoral hernia operation!

23. Spermatic cord and opened inguinal canal Details: next semester

24. Inguinal canal deep inguinal ring superficial inguinal ring Borders:
Sobota - Atlas of Human Anatomy
Borders:
Anterior: fascia of external oblique abdominal muscle
Superior: internal oblique abdominal muscle, transversus abdominis muscle
Inferior: inguinal ligament
Posterior: transversalis fascia, peritoneum
Content:
Spermatic cord in males, round ligament of the uterus in females

25. Inguinal herniation deep inguinal ring superficial inguinal ring
More common in males.
Starts above the inguinal ligament
Sobota - Atlas of Human Anatomy
Indirect inguinal herniation:
Starts at the deep inguinal ring, positioned in between the components of the spermatic cord, travels through the inguinal canal and can reach as far as the testis (testicular herniation).
Direct inguinal herniation:
Starts more medially, at the superficial inguinal ring. Not within, but next to the spermatic cord, usually do not reach the testis

26. Indirect (B) és direct (C) inguinal herniation

27. Netter: Atlas of Human Anatomy

28. Obturator canal
Obturator foramen covered by obturator membrane and two muscles, obturator externus and internus.
Only a small canal is left:
obturator canal
It connects the pelvis to the adductor compartment of the thigh.
Contents: obturator artery, vein, nerve
"obturator herniation„ - rare

29. Obturator herniation

30. Literature
Szentagothai J, Réthelyi M: Funkcionális anatómia, Medicina, 1989
Sobota - Atlas of Human Anatomy, 20th edition, Urban and Schwarzenberger, 1993
Renner Antal: Traumatológia, 2nd edition, Medicina, Budapest, 2003
Vízkelety Tibor: Az ortopédia tankönyve, 2nd edition, Semmelweis Kiadó, 1999
Radiologic images: