The intertrochanteric line is a rough bony ridge on the anterior surface of the proximal femur running from the greater trochanter superolaterally to the lesser trochanter inferomedially. It marks the anterior boundary between the femoral neck and the femoral shaft and provides attachment for the iliofemoral ligament (Y-ligament of Bigelow) of the hip joint. The hip joint capsule attaches along this line anteriorly.
The intertrochanteric line is the border along which hip arthroplasty incisions and femoral osteotomies are planned. Intertrochanteric fractures follow a line from the greater trochanter to the lesser trochanter and are extracapsular fractures, meaning the femoral head blood supply is generally preserved. Unlike femoral neck (intracapsular) fractures, intertrochanteric fractures typically heal well with fixation (dynamic hip screw or cephalomedullary nail) with low rates of avascular necrosis.
Extracapsular fractures along the intertrochanteric line in elderly patients from low-energy falls follow the iliofemoral ligament attachment, producing external rotation and shortening of the limb; the extracapsular location preserves femoral head blood supply allowing healing after dynamic hip screw or intramedullary nail fixation without arthroplasty in most cases.
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