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Topic

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Greater trochanter

The greater trochanter is a large, quadrilateral bony projection on the proximal lateral femur, situated lateral to the femoral neck and just inferior to the femoral head. It serves as a major muscular and tendinous attachment site and is an important surface landmark in clinical examination, orthopedic surgery, and radiology.

The greater trochanter has four distinct surfaces:

  • Lateral surface: broad and convex, palpable externally, providing attachment for the gluteus medius and minimus tendons.

  • Medial surface: features the trochanteric fossa, providing insertion for the obturator externus.

  • Anterior surface: site of gluteus minimus insertion.

  • Posterior surface: broad area for gluteus maximus attachment.

It also has borders: the superior border attaches to gluteus medius, and the inferior border is continuous with the femoral shaft. Its palpable prominence makes it a crucial landmark for intramuscular injections and orthopedic procedures.

Muscular Attachments

  • Gluteus medius: lateral surface, superiorly

  • Gluteus minimus: anterior surface

  • Piriformis: superior border

  • Obturator internus & gemelli: medial aspect at trochanteric fossa

  • Obturator externus: trochanteric fossa (medial surface)

  • Gluteus maximus: posterior border (upper fibers)

Relations

  • Overlain by trochanteric bursa, often involved in trochanteric bursitis

  • Lateral to femoral neck, forming a landmark for hip joint imaging

  • Palpable just below the iliac crest in clinical exams

Synonyms

  • Trochanter major

  • Great trochanter of femur

  • External femoral tuberosity

Function

  • Provides multiple muscle attachment sites for abductors, rotators, and extensors of the hip

  • Acts as a lever arm for hip movement

  • Serves as a palpable surface landmark for injection sites and surgery

  • Important in stabilization of hip during locomotion

Nerve Supply (related muscles)

  • Gluteus medius/minimus: superior gluteal nerve (L4–S1)

  • Piriformis: nerve to piriformis (S1–S2)

  • Obturator internus & gemelli: nerve to obturator internus (L5–S2)

  • Obturator externus: obturator nerve (L3–L4)

  • Gluteus maximus: inferior gluteal nerve (L5–S2)

Arterial Supply

  • Medial femoral circumflex artery (branch of profunda femoris)

  • Lateral femoral circumflex artery

  • Superior and inferior gluteal arteries

  • Trochanteric anastomosis provides collateral circulation

Venous Drainage

  • Follows arterial supply → profunda femoris vein → femoral vein

MRI Appearance

T1-weighted images:

  • Bone cortex: hypointense (dark)

  • Bone marrow: intermediate signal intensity with fatty marrow pattern

  • Attachments of tendons and bursa clearly seen

T2-weighted images:

  • Cortex: hypointense rim

  • Marrow: variable signal depending on fat vs edema

  • Trochanteric bursitis: hyperintense fluid adjacent to lateral surface

PD Fat-Saturated:

  • Cortex: remains dark

  • Marrow edema or stress injury: hyperintense

  • Bursitis, tendon pathology, or enthesopathy appear bright against suppressed fat background

STIR:

  • Excellent for detecting marrow edema, occult fractures, bursitis, or tendinopathy

  • Fractures appear as hyperintense lines surrounded by edema

T1 Post-Gadolinium (with fat saturation):

  • Normal bone cortex: no enhancement

  • Pathology (infection, tumor, bursitis): enhances with increased vascularity

  • Useful for distinguishing tumor vs inflammatory changes

3D T2-weighted Imaging:

  • Cortex: hypointense, sharp margins

  • Provides multiplanar reconstruction of greater trochanter morphology, tendon insertions, and bursae

  • Useful for preoperative planning in hip preservation surgery

CT Appearance

Non-contrast CT:

  • Cortex: hyperdense, well defined

  • Marrow: relatively hypodense compared to cortex

  • Excellent for fractures, cortical irregularities, and bone morphology

CT Post-Contrast:

  • Bone: unchanged

  • Soft tissues/bursa: may show enhancement in bursitis, tumors, or infection

  • 3D CT reconstructions valuable in trauma evaluation and hip arthroplasty planning

CT VRT 3D image

Greater trochanter 3d ct image

CT image

Greater trochanter CT axial image

MRI image

Greater trochanter MRI axial anatomy image-img-00000-00000

MRI image

Greater trochanter MRI CORONAL anatomy image-img-00000-00000