In addition to adjacent muscles, the superior gluteal artery contributes to the supply of the hip joint. Branches of the artery also anastomose with the lateral and medial femoral circumflex arteries from the deep femoral artery in the thigh, and with the inferior gluteal artery (Fig. 6.51).
Inferior and superior gluteal veins follow the inferior and superior gluteal arteries into the pelvis where they join the pelvic plexus of veins. Peripherally, the veins anastomose with superficial gluteal veins, which ultimately drain anteriorly into the femoral vein.
Deep lymphatic vessels of the gluteal region accompany the blood vessels into the pelvic cavity and connect with internal iliac nodes.
Superficial lymphatics drain into the superficial inguinal nodes on the anterior aspect of the thigh.
The thigh is the region of the lower limb that is approximately between the hip and knee joints (Fig. 6.52):
Anteriorly, it is separated from the abdominal wall by the inguinal ligament.
Posteriorly, it is separated from the gluteal region by the gluteal fold superficially, and by the inferior margins of the gluteus maximus and quadratus femoris on deeper planes.
Structures enter and leave the top of the thigh by three routes:
Posteriorly, the thigh is continuous with the gluteal region and the major structure passing between the two regions is the sciatic nerve.
Anteriorly, the thigh communicates with the abdominal cavity through the aperture between the inguinal ligament and pelvic bone, and major structures passing through this aperture are the iliopsoas and pectineus muscles; the femoral nerve, artery, and vein; and lymphatic vessels.
Medially, structures (including the obturator nerve and associated vessels) pass between the thigh and pelvic cavity through the obturator canal.
The thigh is divided into three compartments by intermuscular septa between the posterior aspect of the femur and the fascia lata (the thick layer of deep fascia that completely surrounds or invests the thigh; Fig. 6.52C):
The anterior compartment of the thigh contains muscles that mainly extend the leg at the knee joint.
The posterior compartment of the thigh contains muscles that mainly extend the thigh at the hip joint and flex the leg at the knee joint.
The medial compartment of the thigh consists of muscles that mainly adduct the thigh at the hip joint.
The sciatic nerve innervates muscles in the posterior compartment of the thigh, the femoral nerve innervates muscles in the anterior compartment of the thigh, and the obturator nerve innervates most muscles in the medial compartment of the thigh.
The major artery, vein, and lymphatic channels enter the thigh anterior to the pelvic bone and pass through the femoral triangle inferior to the inguinal ligament. Vessels and nerves passing between the thigh and leg pass through the popliteal fossa posterior to the knee joint.
The skeletal support for the thigh is the femur. Most of the large muscles in the thigh insert into the proximal ends of the two bones of the leg (tibia and fibula) and flex and extend the leg at the knee joint. The distal end of the femur provides origin for the gastrocnemius muscles, which are predominantly in the posterior compartment of the leg and plantarflex the foot.
Shaft and distal end of femur
The shaft of the femur is bowed forward and has an oblique course from the neck of the femur to the distal end (Fig. 6.53). As a consequence of this oblique orientation, the knee is close to the midline under the body’s center of gravity.