The greater trochanter is the large bony prominence at the proximal lateral femur, serving as the insertion site for the gluteus medius, gluteus minimus, piriformis, obturator internus, gemelli, and obturator externus muscles. It is the primary muscle attachment point for hip abduction and external rotation, and its fracture from high-energy trauma or avulsion in young athletes disrupts these functions. Greater trochanteric pain syndrome involves tendinopathy and bursitis at this prominently subcutaneous landmark.
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| Ossification | The greater trochanter develops from its own apophyseal ossification centre appearing at age 4 and fusing with the femoral shaft at age 16 to 18. Its open apophysis in adolescents is the site of the avulsion fractures that do not occur in adults. |
Greater trochanter apophyseal avulsion fractures in adolescent athletes (particularly gymnasts and sprinters) occur from sudden hip abductor contraction, producing lateral hip pain and inability to abduct. Displaced avulsions (greater than 1 to 2 cm) may require surgical fixation. In adults, greater trochanteric fractures in hip arthroplasty from periprosthetic fracture require fixation with claw plate devices. The greater trochanter is the primary landmark for hip arthroplasty posterior approach incision placement.
Place the flat of your hand on the outer side of the hip, about a hand's breadth below the iliac crest. Rotate the person's leg in and out; the large bony mass that rolls under your hand is the greater trochanter. Its upper border lies roughly level with the centre of the hip joint.
Lateral hip pain from gluteus medius and minimus tendinopathy and trochanteric bursitis, common in middle-aged women.
An isolated fracture after a fall onto the side of the hip, which may hide an occult intertrochanteric extension on MRI.
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