how to loacteneck of femur on skin
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surface marking neck of femur skin anatomy greater trochanter inguinal ligament
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https://uomustansiriyah.edu.iq/media/lectures/2/2_2018_02_27…
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Surface Marking of the Neck of Femur on Skin
The neck of femur lies deep in the hip region and cannot be palpated directly, but it can be accurately located using bony surface landmarks.
Key Bony Landmarks to Identify First
Before marking the neck, you need to locate three palpable points:
| Landmark | How to find it |
|---|---|
| Anterior Superior Iliac Spine (ASIS) | Felt at the lateral end of the fold of the groin (inguinal fold) |
| Pubic tubercle | Small bony projection at the medial end of the fold of the groin |
| Greater trochanter | Prominent lateral bony bump, about a hand's breadth below the tubercle of the iliac crest; forms a prominence in front of the hollow on the lateral side of the hip |
Surface Marking of the Neck of Femur
The neck of the femur is marked on the skin as follows:
- Draw a line from the ASIS to the pubic symphysis - this corresponds to the inguinal ligament.
- Find the midpoint of this line. At the midpoint, drop a perpendicular downward and laterally toward the greater trochanter.
- The neck of femur lies along a line drawn from the greater trochanter directed medially, superiorly, and slightly anteriorly toward the femoral head, at an angle of approximately 125-130° (the angle of inclination) with the femoral shaft.
- More practically: the neck runs from the tip of the greater trochanter toward a point below the midpoint of the inguinal ligament (where the femoral head sits in the acetabulum).
Classic Clinical Rule
The neck of femur is directed medially, upward, and anteriorly from the shaft. It is located just below and lateral to the midpoint of the inguinal ligament, projecting toward the femoral head in the acetabulum.
Why This Matters Clinically
- Bryant's Triangle helps detect upward displacement of the greater trochanter in fracture neck of femur:
- Draw a vertical line from the ASIS downward
- Draw a horizontal line from the greater trochanter to meet it
- Shortening of the horizontal limb = upward migration of the trochanter, indicating fracture neck of femur, posterior dislocation, or upper femoral epiphysis separation
- In a fracture of the neck of femur, the greater trochanter recedes from (moves away from) the ASIS due to external rotation of the femur
- In posterior dislocation, the trochanter moves toward the ASIS due to internal rotation
Clinical Sign on Examination
When fracture of the neck of femur occurs, the patient presents with:
- External rotation of the lower limb (due to overriding pull of psoas major on the lesser trochanter)
- Shortening of the limb
- The greater trochanter rises above Nelaton's line (a line from ASIS to the ischial tuberosity)
(Sources: S Das - A Manual on Clinical Surgery 13th Ed, p.202; Gray's Anatomy for Students; Anatomy of the Lower Limb - Dr. Hayder)
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