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Intertrochanteric crest

The intertrochanteric crest is a prominent bony ridge on the posterior aspect of the proximal femur, extending from the greater trochanter to the lesser trochanter. It provides an important attachment site for the quadratus femoris muscle and marks the transition between the femoral neck and proximal shaft.

It forms the posterior boundary of the intertrochanteric region, complementing the anterior intertrochanteric line. The crest plays a structural role in posterior hip stability, serves as a landmark in orthopedic surgery, and contributes to muscle leverage during hip rotation.

Synonyms

  • Crista intertrochanterica

  • Posterior intertrochanteric ridge

Location and Structure

  • Position: Posterior surface of the proximal femur

  • Orientation: Oblique ridge running inferomedially from the greater trochanter to the lesser trochanter

  • Associated landmarks:

    • Quadrate tubercle: A raised prominence near the midpoint where quadratus femoris inserts

    • Posterior border separating trochanteric fossa from the proximal shaft

Relations

  • Anteriorly: Femoral neck

  • Posteriorly: Hip external rotator muscles (quadratus femoris, gemelli, obturator externus)

  • Laterally: Greater trochanter

  • Medially: Lesser trochanter

  • Inferiorly: Posterior proximal femoral shaft

Attachments

  • Quadratus femoris muscle: Inserts along the quadrate tubercle on the crest

  • Posterior hip capsule: Attaches partially along the crest

  • Serves as a palpable surgical landmark for hip approaches

Function

  • Provides a strong bony anchor for quadratus femoris, assisting in external rotation and adduction of the thigh

  • Contributes to posterior hip joint stability

  • Serves as a radiographic and surgical landmark in hip fracture fixation and prosthetic placement

Clinical Significance

  • Important in identifying proximal femur morphology on imaging

  • Quadratus femoris injuries may involve traction at the intertrochanteric crest

  • Hip fractures (intertrochanteric or subtrochanteric) may extend toward or involve the crest

  • Used as a reference point during hip arthroplasty and open reduction procedures

MRI Appearance

T1-weighted images:

  • Cortical bone of the crest appears low signal (dark)

  • Adjacent bone marrow: bright, fatty signal

  • Muscle insertions appear as low-signal tendinous fibers attaching to the cortex

  • Provides sharp delineation of the posterior proximal femoral contour

T2-weighted images:

  • Cortical bone remains low signal

  • Marrow: bright, though slightly less intense than on T1

  • Surrounding muscles: intermediate-to-low signal

  • The crest appears as a continuous dark line marking the posterior femoral border

STIR:

  • Cortical bone: dark, sharply demarcated

  • Surrounding fat suppressed

  • Normal marrow: intermediate-to-dark, depending on fat suppression efficiency

  • Excellent for evaluating soft tissues adjacent to the crest

CT Appearance

Non-Contrast CT:

  • Crest appears as a high-density bony ridge between greater and lesser trochanters

  • Quadrate tubercle seen as localized thickening along the ridge

  • Provides excellent depiction of cortical thickness and continuity

  • Useful for evaluating fracture extension or cortical irregularity

MRI image

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MRI image

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MRI image

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