The morphologic relationship of the lesser trochanter with the femoral neck and greater trochanter

Background: The anatomy of the proximal femur comprises important landmarks for many orthopedic surgical procedures. However, this area exhibits morphological differences depending on race, gender and age. Besides being the insertion area of the hip flexor muscles, the lesser trochanter is also used as an angular reference in many orthopedic surgical procedures. The aim of this study is to investigate the morphologic relationship of the lesser trochanter with the femoral neck and greater trochanter.Methods: Around 67 dry femur bones (32 left, 35 right) belonging to humans of unknown gender that belong to the Ankara University Medical Faculty, Department of Anatomy were used in this study. The morphologic relationship of the lesser trochanter (TRMI) with the femoral neck (FN) and greater trochanter (TRMJ) was studied and the results were provided in a table.Results: The measured mean lesser trochanter and greater trochanter tip distance was 67.5±4.9mm (60mm-75mm). The angle between the tip of the lesser trochanter and the center of the femoral neck was measured as 35.050±5.060 (290-420) degrees. The distance between the tip of the lesser trochanter and the center of the femoral neck was measured as 15±2.8mm (10mm-20mm).Conclusions: In addition to the angular relationship of the lesser trochanter with the femoral neck, its relationship in terms of distance with the greater trochanter and femoral neck are the anatomic relationships that are noteworthy for the lesser trochanter, which is used as a landmark during orthopedic surgical procedures.

Solitary Osteochondroma: Rare Occurrence A Report of Two Cases.

Solitary Osteochondroma is the most common benign bone tumor, and occurs most frequently in the proximal humerus, tibia, and distal femur. It rarely affects proximal femur and talus. Therefore, we report two cases of solitary osteochondroma, which were found at these rare sites (one at lesser trochanter and another at talus) with a brief review of literature and discussion of clinical features and management..

Ischiofemoral Impingement Syndrome: Outcomes of Endoscopic Resection of the Lesser Trochanter

Ischiofemoral impingement syndrome is a rare clinical entity characterized by chronic groin, buttock or hip pain associated with radiographic evidence of narrowing of the space between the lesser femoral trochanter and the ischial tuberosity. Introduction of magnetic resonance imaging to the clinical practice as well as the establishment of the radiological definition of the abnormal ischiofemoral distance has led to an increasing interest in this condition. Ischiofemoral impingement syndrome is a poorly understood disorder of chronic pain, especially regarding its treatment. The authors present two cases of primary ischiofemoral impingement syndrome successfully treated with a minimally invasive surgical technique. With this endoscopic technique, it was possible to resect the lesser trochanter and restore the ischiofemoral space. Immediate clinical and functional improvement was reported by both patients.

Fixaton of Lesser Trochanteric Fragments on an Unstable Intertrochanteric Fracture of the Femur

PURPOSE: We evaluated the effect of cable fixation of the lesser trochanter for treating unstable intertrochanter fractures. MATERIALS AND METHODS: In this retrospective study, we assessed the availability of cable fixation of the lesser trochanter and the cause of complications in a series of 47 unstable intertrochanteric femoral fractures that were seen between February 2001 to May 2008 at our hospital. The fractures were classified using the Evans-Jensen classification system. The lesser trochanters were fixed in 21 cases. The correlations between the lag screw position, comminution of the fracture site and the radiological results were studied. Nonunion was diagnosed if patients experienced pain and the radiographs revealed a persistent, radiolucent defect at the fracture site 6 months after fracture fixation. RESULTS: Union was observed in 43 cases (91.5%). The average union time was 3.75 months. Nonunion was observed in 4 cases (8.5%) 1 in group l and 3 in group ll. The average sliding distance of the lag screw was 8.76 mm. In groups l and ll, the distance was 4.92 mm and 12.45 mm, respectively. Excessive sliding, which was defined as more than 15mm, developed in 9 cases, and 7 of these 9 cases were in group ll. The average neck-shaft angle change was 1.28degrees and 5.81degrees, respectively. CONCLUSION: Additional cable fixation of the lesser trochanter for treating intertrochanter fractures, including large posteromedial fragments, is recommended for preventing the excessive sliding of lag screws and varus deformity.

Treatment of OTA type A2 Intertrochanteric Fractures of the Femur Using Sliding Hip Screw: An Analysis of Risk Factors

PURPOSE: This study was performed to evaluate the risk factors affecting the failure of fixation and to analyze the clinical and radiologic results after operation with using a sliding hip screw for treating OTA type A2 intertrochanteric fractures of the femur. MATERIALS AND METHODS: From January 2001 to June 2005, we reviewed the clinical records and the serial radiographs of 53 patients (OTA type A2 intertrochanteric fractures of the femur) who were treated with a 135-degree angled sliding hip screw. We analyzed the change in the neck-shaft angle, the sliding distance and failure of the sliding screw, according to the reduction of the lesser trochanteric fragment and the stability of the lateral buttress. RESULTS: Among 53 patients, there were 15 cases (28.3%) of failures to reduce the lesser trochanteric fragment. Losses of the lateral buttress were observed in 35 cases (66.0%). There were 8 cases (15.1%, 8/15) that failed radiologically, including cutting out of the sliding hip screw from a femoral head (3 cases), metal failure (1 case) and excessive sliding (4 cases). There were significantly differences for the changes of the angle of the neck-shaft, the distance of sliding and the length of penetration of the sliding hip screw, according to the reduction of the lesser trochanteric fragment and the stability of the lateral buttress. CONCLUSION: It is important to consider the reduction of the lesser trochanteric fragment and the stability of lateral buttress when treating OTA type A2 intertrochanteric fractures with using a sliding hip screw.

Biomechanical changes of proximal femur for posteriomedial fractures:a finite element analysis / 中国矫形外科杂志

[Objective]To research the biomechanical influence of posteriomedial fractures on proximal femur.[Method]Three dimensional finite element models of intact and osteotomied proximal femurs were established from computerized tomographic(CT)scanning images,and finite element analysis was undertaken.[Result]The maximum equivalent stress was located at the anteriomedial of the defection of the proximal femur.The stress of femoral neck,as well as the medial and lateral femoral cortex was not significantly changed after isolated lesser trochanteric fracture.However,with half of the medial cortex involved,the stress of the medial and lateral femur increased by 47% and 12%,respectively.If the entire medial cortex was involved,the stress of medial and lateral femur increased by 247% and 66%,respectively.[Conclusion]Different types of posteriomedial fragments have different effects on the stress distribution and quantity of proximal femur.When treating intertrochanteric fractures using dynamical hip screw,the fragments should be differently treated based on its types considering for biomechanical effects.

Anatomical study of the method of internal fixation of the lesser trochanter from the lateral shaft of femur / 中国矫形外科杂志

[Objective]To study the pertinency of position of the lesser trochanter and lateral shaft of femur for internal fixation of fracture of the lesser trochanter.[Method]One hundred and twenty thigh bones were taken X-ray films on normotopia and lateral position,anatomical observation and measurement of the the lesser trochanter were completed with angel and length relative to lateral shaft of femur.[Result]Vertical axis length of the lesser trochanter was 26.38?2.44 mm and transverse diameter was 15.61?1.49mm.Its retroverted angle was 17.66??10.56?and uptilted angle was 26.33??3.33?.[Conclusion]The appropriate position in fixation of the fracture of the lesser trochanter is the point on the besctor of the lateral cortex of the femur on level of the lower of the lesser trochanter.Its retroverted angle is 10?-15?and uptilted angle is 25?-30?.The length of the screw is 45-50 mm,it is beneficial to design the plate in femur with the data.

New Wiring Method for Lesser Trochanter Fixation in Unstable Intertrochanteric Fractures: Technical Note

In unstable femoral trochanteric fracture, we usually used transversing K-wires through the lesser trochanter to achieve an anatomical reduction, and using sliding hip screws. However, in patients with comminuted lesser trochanter or osteoporosis, an intrusion of the wire into the lesser trochanter and/or iatrogenic intertrochanteric fractures were often resulted. Those who were not familiar with a technique of puncturing two holes through the lesser trochanter might have had to face some difficulties. In order to overcome aforementioned drawbacks, the authors had quite satisfactory results by employing the method of passing each of two wires above and below the iliopsoas muscle, and they were twisted posteriorly and then anteriorly; and finally they were pulled together posteriorly. Through this technique, both firm fixation of the lesser trochanter and more stable bony union were obtained.

Comminuted intertrochanteric fractures: Should the lesser trochanteric fragment be fixated? / 中华创伤骨科杂志

Objective Unstable intertrochanteric hip fractures are characterized by comminution of the posteromedial cortex and a fragment of variable size containing the lesser trochanter. This paper is to discuss whether it is necessary to perform reduction and fixation for this fragment. Methods 67 cases of intertrochanteric fractures were treated by dynamic hip screw (DHS) fixation between March 2001 and September 2002 and followed up for a minimum of 1 year. Their treatment results were retrospectively analyzed. Results No nonunion, coxa vara or failure of internal fixation occurred in all these patients. Conclusion If DHS provides stability, screw fixation of the lesser trochanteric fragment is unnecessary.

Treatment of Unstable Trochanteric Fracture Using Sliding Hip Screw with Wiring of Lesser Trochanter / 대한정형외과학회잡지

PURPOSE: To evaluate the effect of the sliding hip screw with wiring of lesser trochanter for the treatment of unstable trochanteric fractures. MATERIALS AND METHODS: we analysed retrospectively 39 cases between 1995 and 1999. All cases were followed up for more than 1 year. Using modified Watson-Jonson approach, we performed reduction of the fracture as anatomically possible extent. RESULTS: Bony union was obtained in average 6 months. Nonunion with metal failure occurred in one case. The average sliding of lag screw was 11mm. The average change of neck-shaft angle (NSA) was 1.8degrees respectively. Satisfactory NSA was achieved in 33 cases except 2 cases of varus and 4 cases of valgus both exceeding 10degrees. CONCLUSION: The sliding hip screw with wiring of lesser trochanter is a useful option for unstable trochanteric fractures because of its initial stability as buttress effect on posteromedial cortex to allow early ambulation.

Prediction of Rotationally Neutral State of the Femur by Comparing with the Shape of Contra-lateral Lesser Trohanter / 대한정형외과학회잡지

PURPOSE: To evaluate the accuracy and reliability of method for prediction of rotationally neutral state of the femur by comparing with contra-lateral lesser trochanter. MATERIALS AND METHODS: The rotationally neutral state of the femur was measured by comparing the shape of the opposite side of the lesser trochanter in a normal group of 100 adult. Each examination was performed independently by three observers. The observers predicted a position presumed to be neutral by comparing the shape of lesser trochanter with that of contra-lateral side previously recorded by the C-arm image intensifier. We evaluated the mean angular discrepancy that is different from the neutral point and assessed the inter-observer variations. RESULTS: The mean angular discrepancy (SD) was 3.4 degree(+/-2.4); 3.5 degree(+/-2.4) by observer-1,3.5 degree (+/-2.8) by observer-2, 3.2 degree(+/-2.2) by observer-3. There was no inter-observer variation (p=0.87). 77% of all observers indicated below 4 degree and no one over 15 degree. CONCLUSIONS: The method of comparing the shape of both lesser trochanters is considered to be effective in determining the rotational status of the femur. It could be used as a practical method in the operation of the femoral fracture for prevention of rotational deformity intra-operatively

Changes of the Fracture Fragments of Lesser Trochanter after Operative Treatment in the Unstable Femoral Intertrochanteric Fractures / 대한정형외과학회잡지

Unstable femoral intertrochanteric fractures are characterized by comminution of the posteromedial cortex, resulting in a fragment of variable size containing the lesser trochanter. Need for fixation of the fracture fragment of lesser trochanter remained controversial. We assessed the superior and medial migration of the fracture fragment of lesser trochanter, bone union, change of hip flexor power, limitation of motion and clinical results in a 29 unstable femoral intertrochanteric fractures which had been internally fixed with gamma interlocking nail (14 cases), compression hip screw (10 cases) and anatomical bent plate (5 cases). The fracture fragment of lesser trochanter was fixed with long trans-fixation screw in the cases of the anatomical bent plate. Superior migration of the fracture fragment of lesser trochanter is statistically different between Gamma interlocking nail and the other operations (P0.05). Although the stability could be provided by trans-fixation of the fracture fragment of lesser trochanter because the fragment acts as a buttress, clinical results was not influenced whether the fixation of the fracture fragment of lesser trochanter was done or not. We conclude that additional trans-fixation screw doesn t need if major fracture site was firmly fixed through any operation.