What Is the Greater Trochanter?

The upper and outer square bulges where the femoral neck is connected to the body are called the greater trochanter. It is an important sign to measure the length of the lower limbs and judge the femoral neck fracture or hip dislocation.

The upper and outer square bulges where the femoral neck is connected to the body are called the greater trochanter. It is an important sign to measure the length of the lower limbs and judge the femoral neck fracture or hip dislocation.

Chinese name

Big rotor

Foreign name

The greater trochanter

Location

Femoral neck and body junction

Features

Human body bending part

Greater trochanter blood supply

The posterior femoral trochanter is rich in external blood supply and has multiple blood vessels. It is a valuable bone supply area newly developed in recent years. The deep branches of the medial femoral rotation, the anastomotic branch of the inferior gluteal blood vessel, and the ascending branch of the first perforating blood vessel all converge. In this part, a constant anastomosis network is formed.

Morphological characteristics and area of fascia and periosteum in the greater trochanter

The fascia is thick and consists of dense connective tissue, divided into two layers, shallow and deep. It is continuous with myofascial fascia attached to the greater trochanter, such as the quadriceps femoris and gluteal muscle, and passes through the gluteal fascia and the trochanter. Loose connective tissue. The periosteum is thick and consists of dense connective tissue, which is closely attached to the bone surface and difficult to separate. The length of the fascia from the tip of the greater trochanter to the plane of the smaller trochanter is 6.7 ± 1.2 cm (x ± s, the same below), the width from the femoral muscle stop to the outer edge of the greater trochanter is (4.8 ± 0.8) cm, and the area is (32.5 ± 7.8) cm. The length of the periosteum from the tip of the greater trochanter to the lower edge of the femoral muscle was (6.1 ± 1.1) cm, the width from the intertrochanteric ridge outward was (4.1 ± 0.3) cm, and the area of the periosteum was (25.1 ± 7.4) cm.

Vascular origin and distribution of fascia and periosteum in the greater trochanter

The fascial vessels are divided into shallow and deep layers, which are located on the surface of the shallow and deep fascia respectively. Periosteal blood vessels are located on the surface of the periosteum. The vascular sources of fascia and periosteum have multiple origins and homology. Homology means that the fascial and periosteal blood vessels distributed in a certain area of the greater trochanter come from the same arterial trunk. Xu Dachuan and Yao Zuobin called such vascular stems as fascia periosteum vessels.

Design of great trochanter with trochanter fascia periosteal bone flap

The deep branch of the medial circumflex femoral artery and the greater trochanteric branch of the inferior gluteal artery are the main nutritional blood vessels of the great trochanteric fascioperiosteal bone flap of the femoral muscle pedicle. When designing the tissue flap, these two blood vessels or one of them can be used as the main nutritional blood vessel. The vessels of the femoral muscle fascia and the great trochanter fascia near its stops are called the great trochanter fascia periosteal bone flap with fascial vessels. 6cm × 4cm fascia, 5cm × 3cm periosteum, and 4cm × 2cm bone flap can be excised. The fascia and periosteum wrap around the bone flap during implantation. The fascial periosteal bone flap cut in this way has three sources of blood supply: the deep branches of the medial circumflex femoral artery and / or the greater trochanteric branch of the inferior gluteal artery; the nutritional vessels of the femoral muscle; and the fascial vessels of the femoral muscle. The periosteal bone flap with fascial vessels increases the nutritional effect of fascial vessels on the basis of traditional periosteal blood vessels. Therefore, periosteal bone flaps with fascial vessels have a richer blood supply than periosteal bone flaps without fascial vessels, which is beneficial to fractures. Healing. Huang Xiangjie used deep fascia as the pedicled periosteal bone flap to treat tibial non-connection, Li Zhongwen used fascial femoral periosteal bone flap displacement and screw internal fixation to treat femoral neck fractures successfully. Baksi treated the femoral neck fracture with femoral muscle pedicled great trochanteric bone flap without fascia. In some cases, the fracture did not heal.

Anatomy points of the greater trochanter

Anatomy points of transposition of the greater trochanter fascia periosteal bone flap of the femoral muscle pedicle:

When taking fascia periosteal bone flaps, the principle is that the area of the fascia is larger than the periosteum, and the area of the periosteum is slightly larger than the bone flap; Continuity; Within the range of periosteal flaps, do not separate the fascia from the periosteum, so as not to damage the anastomosis of the fascial and periosteum vessels; Do not damage the greater trochanteric branch of the inferior gluteal artery when separating the lateral part of the upper edge of the femoral muscle The great trochanteric fascia branch and periosteum branch of the deep branch of the medial femoral artery and the deep branch of the medial circumflex femoral artery; Close the foramen muscle in front of the medial circumflex femoral artery to separate the femoral muscles to avoid damaging the deep branches of the medial femoral circumflex artery. Square muscle branch.