Page 240 - Clinical Anatomy

ECA4 7/18/06 6:47 PM Page 225

The bones and joints of the lower limb 225

Fig. 166◊The immediate relations of the hip joint (in diagrammatic horizontal
section).

A note on growing ends and nutrient foramina
in the long bones

The shaft of every long bone bears one or more nutrient foramina which are
obliquely placed; this obliquity is due to unequal growth at the upper and
lower epiphyses. The artery is obviously dragged in the direction of more
rapid growth and the direction of slope of entry of the nutrient foramen
therefore points away from the more rapid growing end of the bone.
The direction of growth of the long bones can be remembered by a little
jingle which runs:
‘From the knee, I flee
To the elbow, I grow.’
With one exception, the epiphysis of the growing end of a long bone is
the first to appear and last to fuse with its diaphysis; the exception is the
epiphysis of the upper end of the fibula which, although at the growing
end, appears after the distal epiphysis and fuses after the latter has blended
with the shaft.
The site of the growing end is of considerable practical significance;
for example, if a child has to undergo and above-elbow amputation, the
humeral upper epiphyseal line continues to grow and the elongating bone
may well push its way through the stump end, requiring reamputation.

The bones of the foot

These are best considered as a functional unit and are therefore dealt with
together under ‘the arches of the foot’ (see page 235).