Intertrochanteric

Intertrochanteric refers to the region of the proximal femur located between the greater trochanter and the lesser trochanter. In clinical use, it often describes intertrochanteric fractures, a common type of hip fracture that occurs primarily in older adults and is associated with osteoporosis or low-energy falls.

Anatomy and boundaries: The intertrochanteric region is extracapsular and lies below the femoral neck. It contains the intertrochanteric line and crest, along with cancellous bone that contributes to fracture healing. The region is surrounded by strong muscle attachments from the hip abductors and short external rotators. Blood supply is mainly via branches of the medial and lateral femoral circumflex arteries, which has implications for healing but does not typically predispose the femoral head to avascular necrosis, given its extracapsular location.

Clinical features and diagnosis: Patients with intertrochanteric fractures typically present after a fall or trauma with sudden hip or groin pain, inability to bear weight, and the leg often shortened and externally rotated. Standard evaluation begins with radiographs of the pelvis and hip (AP and lateral views). CT or MRI may be used to assess complex fracture patterns or occult fractures.

Management and prognosis: Most intertrochanteric fractures require surgical fixation to restore mobility and function. Common options include cephalomedullary intramedullary nails and sliding or dynamic hip screws; hemiarthroplasty may be considered in certain cases, such as poor bone quality or fracture patterns unsuitable for fixation. Early mobilization is important to reduce complications. Overall prognosis depends on age, comorbidities, and postoperative complications; avascular necrosis of the femoral head is uncommon due to the extracapsular location.