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Intertrochanteric Crest

crista intertrochanterica

The intertrochanteric crest is the posterior counterpart of the intertrochanteric line, a smooth rounded ridge on the posterior surface of the proximal femur connecting the posterior aspect of the greater trochanter to the lesser trochanter. The quadratus femoris muscle inserts on the quadrate tubercle, a small roughening at the midpoint of the crest. The calcar femorale is the dense cortical plate at the posteromedial neck-shaft junction, the key structural element in proximal femoral loading.

Region: Pelvis & Hip

Clinical Relevance

Clinical Notes

The intertrochanteric crest and the calcar femorale are key references in total hip arthroplasty stem sizing and positioning. The calcar is the dense bone that must support the femoral stem medially; inadequate calcar support leads to varus stem positioning and stress shielding of the proximal femur. In cemented stems, the calcar preparation (broaching) must be accurate to ensure correct leg length and offset. Metastatic disease often involves the calcar first because of its high trabecular bone density and marrow vascularity.

Pathology

Common Injuries & Conditions

Calcar Fracture During Femoral Canal Preparation in Arthroplasty

Aggressive broaching or rasping of the proximal femoral canal during total hip arthroplasty may crack the posteromedial calcar at the intertrochanteric crest level; a calcar crack recognised intraoperatively is cerclaged with wire before stem insertion to prevent fracture propagation and loss of proximal fixation.