Book One -- The things that sustain and support the entire body, and what braces and attaches them all. [the bones and the ligaments that interconnect them]

Chapter 30 On the Femur

Index of characters which will be used to mark the two figures of the present chapter on the following page.

A 1, 2 Head of the femur [caput femoris], entering the acetabulum of the hipbone [os coxae].
B 1 Depression [fovea capitis femoris] incised in the head of the femur, receiving the insertion of a rounded ligament [lig. capitis femoris] from the hipbone.
C 1, 2 Fusion of the epiphysis 1 with the remaining part of the femur, forming the round head of the femur.
D 1, 2 Neck of the femur [collum femoris].
E, F 1, 2 Lower heads of the femur. E marks the inner [condylus medialis], F the outer [condylus lateralis].
G 1, 2 This line marks the fusion of the epiphysis which constitutes the two lower heads of the femur. 2
H 2 Depression [facies patellaris] which is common to the heads marked E and F, and which the patella enters.
I 1 Depression [fossa intercondylaris] and interval separating the two lower heads of the femur from each other.
K 1 From this area of the inner head, the first of the muscles [m. gastrocnemius, caput mediale] that move the foot takes its origin.

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L 1 From here the second [m. gastrocnemius, caput laterale] and third [m. plantaris] of the muscles that move the foot together take their origin.
M 1 Into this area [tuberculum adductorium] of the inner head is inserted the tendon of the fifth of the muscles [m. adductor magnus] that move the femur. We shall place the legend of the remaining letters beneath the figures. 3

N 1, 2 Depression carved in the outer side of the lower heads [epicondylus lateralis] of the femur, conveying the fourth of the muscles [m. biceps femoris] that move the tibia. 4
O 1 At this point the inner side of the inner head [condylus medialis] of the femur is compressed so that tendons of the first, second, third, and fifth muscles 5 that move the tibia may be extended hence.
P 1 In this region the same side of the inner head [epicondylus medialis] protrudes noticeably. 6
Q, R, S, V, X, Y Outer process [trochanter major] of the femur. The individual letters not visible at the same time in both figures mark some separate feature, as I shall now add. Q in the first and second figures marks the fusion of the epiphysis of this process [trochanter major] to the rest of the bone [corpus femoris]; R in the first figure is a depression [fossa trochanterica] carved in the inner surface of this process. S in the first figure marks the first impression [tuberculum quadratum] in the outer process.
T, T In the first figure, these mark a rough line [tuberositas glutealis] running down from the first impression; V in the second figure identifies the second impression in the outer process [trochanter major], X the third impression. Y in both figures marks the fourth impression.
a, b 1, 2 Inner process [trochanter minor] of the femur. b, appearing only in the second figure, shows there the fusion of the epiphysis.
c, c 1 Rough line [linea pectinea] running obliquely downward from the root of the inner process for the eighth [m. pectineus] of the muscles that move the femur.
d, d 1 Line [linea aspera] protruding along the longitude of the femur, admitting the insertion of the fifth of the muscles [m. adductor magnus] that move the femur.
e 1 At this point [facies poplitea] the femur is wide, 7 though it is rounded along most of its remaining length.
f 2 Rough surface [linea intertrochanterica] from which the eighth of the muscles [m. vastus medialis] that move the tibia takes the beginning of its origin.

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The femoral bone 8 (all of figs. 1, 2; L in the skeletons, articulated superiorly with ϖ [os coxae], inferiorly with F [tibia]) exceeds in size all the bones of the human fabric, though in birds and almost all the quadrupeds it yields in length to the tibia and the fibula (when the latter is present). It is jointed above with the hipbone and below, by a different kind of joint, with the tibia. 9

The upper head of the femur
In its upper [proximal] portion, where like its lower [distal] portion it has an epiphysis (C above in figs. 1, 2, G below), it is possessed of an extremely robust head [caput femoris] (A in figs. 1, 2) attached to a lengthy neck [collum femoris] (D in figs. 1, 2) that is inwardly inclined; the head perfectly fits the acetabulum (e, f, g in figs. 1, 2, ch. 29) of the hipbone. This entire head 10 is seen to be smooth and coated with cartilage [cartilago hyalina]; but in the middle a little below the center of its vertex (so to speak), it reveals a narrow, deep, and irregular depression [fovea capitis femoris] (B in fig. 1) in which a smoothly rounded ligament [lig. capitis femoris] (P in fig. 1, ch. 49, Bk. 2) originating from the acetabulum of the hipbone [os coxae] is most firmly implanted.

The two lower heads of the femur and their depression
At its lower end the femur is quite thick, and is separated into two heads 11 [condylus lateralis et medialis] (E, F in figs. 1, 2), the largest of all the heads of bones in the entire body; these extend much farther to the posterior side of the femur than to the anterior, 12 as in fact had been useful for their joint with the tibia. They are articulated (join E, F, I in figs. 1, 2 with G, F, I in fig. 7 ch. 31) with the tibia by mutual entry in such a way that the tibia can only be flexed and extended, but not at all moved to the side, even the slightest bit — no matter how Galen thought it, who in listing the motions of the tibia was deceived by the motion of the femur on the hipbone. 13 The heads of the femur are also extended posteriorly because it was better that the tibia be bent at an angle 14 and not extended beyond a straight line 15 or raised in a forward direction; so because of that motion the heads of the femur do not project at all in the anterior side of the femur. Although in their anterior side these heads show a depression [facies patellaris] (H in fig. 2) common to both, quite wide and coated with cartilage, it was not made to receive any projection of the tibia. You will hear that the orbicular bone [patella] which is not unlike a small shield fits into that depression with an appropriately shaped projection [facies posterior] (A, B, C, D in fig. 2, ch. 32) when the account of that bone is undertaken in the second chapter after this. On the posterior side of the femur these heads [condylus medialis, c. lateralis] are separated from each other by a wide interval (I in fig. 1), and between them they make a wide, deep depression [fossa intercondylaris] that is quite rough and not at all covered with cartilage. It receives the rough and uneven projection [eminentia intercondylaris] (I in fig. 7, ch. 31) of the tibia which we shall write projects between the depressions [facies articularis superior] of the tibia and puts forth a ligament [lig. cruciatum anterius] (X in the figure for ch. 1, Bk. 2) which is very strongly inserted in that depression together with another quite robust ligament [lig. cruciatum posterius] originating from the posterior side of the tibia. This depression assists in bringing down the largest nerve [n. ischiadicus] 16 of the entire body (z, h, q in the 10th table of muscles) together with the vein [vv. tibiales anteriores et posteriores] and the artery [a. tibialis anterior] (r, u in the last figure of Bk. 3) to the tibia. Though the lower heads [condyles] of the femur are brought so far to the rear for the motions of the tibia, they also function to let the nerve and the vessels descend between them with the greatest safety. As processes do, they also provide origins for a number of muscles that move the foot; for 17 the first [m. gastrocnemius, caput mediale] (F in the 12th table of muscles) of the muscles that move the foot originates from the upper side (K in fig. 1) of the inner head [condylus medialis], 18 and from the upper side (L in fig. 1) of the outer head [condylus lateralis] the second [m. gastrocnemius, caput laterale] (Y in the 12th table of muscles) and third [m. plantaris] (F in the 13th) of the muscles responsible for motions of the foot originate. 19 Also, if the muscle [m. popliteus] (G in the 14th table) concealed behind the knee takes some part of its origin from a bone, it surely does so from this outer head [condylus lateralis] of the femur, although its principal origin will be shown to come from the ligament [lig. collaterale fibulare] (T in the figure for ch. 1, Bk. 2) that more than any other secures this head of the femur to the tibia. A tendon (C, then h, z in the 12th table of muscles) is inserted into the upper region (M in fig. 1) of the inner head somewhat toward its inner side; this belongs to the fifth of the muscles [m. adductor magnus] that move the femur; because of this insertion, this head of the femur shows its side compressed there, suited for receiving a tendon [lig. collaterale tibiale]. Dogs show a small ossicle here, like those which we compare to a sesame seed [ossa sesamoidea] (y, w in fig. 2, ch, 33). 20 That is how the anterior, inferior, and posterior sides of these heads are arranged; their sides 21 are filled with many small, blind foramina, so that the very powerful ligaments containing the knee joint may fitly originate from here. The outer side of the outer head [condylus lateralis] puts out a separate depression (N in figs. 1, 2) incised obliquely to it near the posterior region of the side, made for the tendon of the fourth [m. biceps femoris] (Y in the 10th table of muscles) of the muscles that move the tibia. Lest the tendon leave its course when flexed obliquely from here, Nature prepared this depression 22 . The inner side of the inner head [condylus medialis], though several tendons (of muscles L, D, R, V, V in the 16th table of muscles or q, g, b, d, d in the 2nd) 23 are bent upon it, has no such depression. But when the bone has just been cleaned, a compression (O in fig. 1) appears near the posterior area of the side [condylus medialis] by which the tendons can safely be brought down; they do not slip out of place because of a wide convexity that arises (P in fig. 1) in the middle of the side just mentioned and allows the tendons to be brought down opportunely along its posterior surface. The tendons brought down this way will be counted as belonging to the first three and the fifth of the muscles that move the tibia.

Two processes, or rotators, of the femur
Near the neck of the femur [collum femoris] to which is attached the femur’s upper head [caput femoris], two processes are seen, one of which [trochanter major] (Q, Y in figs. 1, 2) occupies the outer [lateral] side of the femur, and is easily the largest of all the processes of the body not attached to another bone; it possesses a conspicuous epiphysis (femurs in the figure for ch. 3, and Q here 24 ). The other [trochanter minor] (a in figs.1, 2) is the lesser, not at all comparable to the former in magnitude, and visible much lower on the inside [medial] of the femur a little toward the posterior. It too is augmented by an epiphysis (b in fig. 2). The Greeks name both troxanth/r, 25 “rotator,” so to speak, calling one the inner and the other the outer. When they say simply

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“the trochanter,” they always mean the outer one, which because of its breadth and a certain resemblance to a buttock they also called glouto/j. 26 The use of these processes is the same as that of nearly all bony processes, which is like a hill to admit the satisfactory insertion of muscles and elegantly provide a place of origin for other muscles. The inner process of the femur, which is slightly elongated and not very uneven, projects so that the tendons of the sixth and seventh (Q and L in the 8th table of muscles, c, d in the 14th) of the muscles [m. iliopsoas] 27 that move the femur may be inserted. At the root of this process a rough line [linea pectinea] (c, c in fig. 1) on the posterior surface of the femur, running obliquely downward somewhere to the rear, and suited for the insertion of the eighth muscle [m. pectineus] (a in the 7th table of muscles) moving the femur. The outer process [trochanter major] of the femur is convex on its outer surface, while on its inner side it has a concavity where it faces the head of the femur. Here it displays a rough and uneven depression [fossa trochanterica] (R in fig. 1), into which are inserted the ninth and tenth (see x, x, y, z, a in the 13th table of muscles) muscles 28 moving the femur. The outer surface, which is convex, shows four impressions in bony and aged people, areas provided to receive the insertions of four muscles (the first [m. gluteus maximus] is P in the 9th table of muscles, the second [m. gluteus medius] S in the 10th, the third [gluteus minimus] S in the 11th, the fourth [m. piriformis] F in the 11th). The first [tuberculum quadratum] (S in fig. 1) is large and looks convex in the posterior area of the process, where the first of the muscles [m. quadratus femoris] that move the femur is implanted with a wide insertion. From the root of this compression a rough line [tuberositas glutealis] (T, T in fig. 1) is brought downward somewhat obliquely along the back of the femur; into this the first muscle [m. gluteus maximus] moving the femur is also very strongly inserted. The second compression (V in fig. 2) is situated in the anterior side of the outer process, more rough and irregular than the first and quite depressed, serving for the insertion of the second muscle [m. gluteus medius] that causes motions of the femur. The third area (X in fig. 2) is seen at the upper surface of the process, situated between the higher parts of the first and second. This one is elevated, and receives the insertion of the third muscle [m. gluteus minimus] moving the femur. The fourth [m. piriformis] (Y in figs. 1, 2) presents itself at the apex of the process; much smaller than the other three, it admits the tendon of the fourth muscle moving the femur. These are the muscles whose insertion the outer process receives, while from its root on its anterior and outer side it provides the origin for the muscle [m. vastus lateralis] (L in the 5th table of muscles, m in the 10th) which will be counted the seventh of those that move the tibia.

The shape of the femur along its length
As regards the remaining shape of the femur (from f to G in fig. 2, c to G in fig. 1), the entire femur is rounded and quite smooth on its anterior surface and sides, surrounded everywhere by the eighth (g in the 7th table of muscles, d, d in the 13th) 29 of the muscles [m. vastus lateralis, intermedius et medialis] moving the tibia, for whose sake the anterior surface of the femur next to the root of its neck is somewhat wide and rough [linea intertrochanterica] (f in fig. 2), the more powerfully for that muscle to originate, and from a larger area. But on its posterior side the femur is brought to something of an edge, and shows a visibly protruding, rough, irregular line [linea aspera] (d, d in fig. 1) extending from the root of the femur’s processes to somewhere beyond the midpoint of its length. Into this line is pertinaciously inserted the fifth (S, C in the 12th table of muscles) of the muscles [m. adductor magnus] moving the femur; this line only (e, e in the 13th table of muscles) in the entire width of the femur is not surrounded by the eighth of the muscles moving the tibia. Near the lower end of this line (e in fig. 1), next to the root of the femur’s lower heads [condylus medialis, condylus lateralis], the femur looks wide and flat, not round, so that the largest vein [v. poplitea] to the tibia may more safely be borne this way along with the artery [a. poplitea] and the nerve [n. tibialis]; but even if the femur were convex at this point, the vein would not slip away from the femur. In any case, the femur would need to broaden and thicken here for the production of its lower heads. 30 The course of the femur (its progress is from A through D, c, c, d, d, to I in fig. 1, or through D, f, to H in fig. 2. See L in the skeletal figs.) does not run in a straight line downward from the acetabulum of the hipbone. The neck of the femur [collum femoris] is instead carried from the head quite obliquely outward, as it were transversely, and from here as it descends to the knee with the rest of its body the femur proceeds once more obliquely to the inside. Surely, Nature did not devise this shape casually, 31 for it is most praiseworthy, and it must be carefully preserved when the bone is fractured, as Hippocrates taught in his book On Fractures. 32 Everyone whose femur is changed from its original shape and made straighter than is useful for a human, is rendered uneven and lame in the knee. How harmful this is not only for running but also for walking and a firm stance, we learn every day by observation. If the neck of each femur were not extended directly away from the hip joint as we have said, what space would remain for the inner muscles that embrace the femur? Again, what room would there be for the nerves, veins, and arteries distributed everywhere in the leg, or for the small glands [nodi lymphatici inguinales] responsible for the propagation of these vessels? 33 For it was not suitable for these to descend through the outer regions of the leg, since in such a case they would be exposed to harm from everything striking it from the outside on any trifling occasion. 34 If therefore it was fitting to prepare this region 35 for several veins, arteries, small glands, and muscles (and quite large ones at that), it was also necessary that the femur remove itself away from the acetabulum and toward the outside. If in certain cases the neck of the femoral head is less outwardly extended, 36 the inguinal areas are narrow and pressed into each other while the femur is unbecomingly abducted outwardly, together with the knee. Deservedly, therefore, the overall shape of the femur is curved and convex in its exterior [lateral] region and slightly concave in the interior [medial]. To an equal and still greater degree, the posterior part of the femur appears flat and concave and its anterior convex, because this course of the femur is well suited to seated positions and to the many tasks we undertake while sitting, when for example we put one femur upon the other. This is not to mention how elegantly the femur makes way for the muscles that occupy its posterior side.

Book One -- The things that sustain and support the entire body, and what braces and attaches them all. [the bones and the ligaments that interconnect them]